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<1>
Accession Number
620323110
Author
Ferrari R.; Camici P.G.; Crea F.; Danchin N.; Fox K.; Maggioni A.P.;
Manolis A.J.; Marzilli M.; Rosano G.M.C.; Lopez-Sendon J.L.
Institution
(Ferrari) Centro Cardiologico Universitario, University Hospital of
Ferrara, Via Aldo Moro 8, Cona, Ferrara 44124, Italy
(Ferrari) Maria Cecilia Hospital, GVM Care and Research, Via Corriera 1,
Cotignola (RA), Italy
(Camici) Vita Salute University, San Raffaele Hospital, Via Olgettina
Milano, 58-60, Milan 20132, Italy
(Crea) Department of Cardiovascular and Thoracic Sciences, Catholic
University, Largo Francesco Vito, 1, Rome 00168, Italy
(Danchin) Cardiology, European Hospital Georges-Pompidiou, 20 Rue Leblanc,
Paris 75015, France
(Fox) National Heart and Lung Institute, Imperial College, Institute of
Cardiovascular Medicine and Science, Royal Brompton Hospital, Sydney
Street, London SW3 6NP, United Kingdom
(Maggioni) ANMCO Research Center, Via A. La Marmora, 36, Florence 50121,
Italy
(Manolis) Department of Cardiology, Asklepeion General Hospital, 1, Vas.
Pavlou Street, Voula, Athens 16673, Greece
(Marzilli) Cardiothoracic Department, Lungarno Antonio Pacinotti, 43, Pisa
56126, Italy
(Marzilli) Nottola Cardiology Division, Localita Nottola, Ospedali Riuniti
Valdichiana Sudest Siena 53045, Italy
(Rosano) Clinical Academic Group, St George's Hospitals NHS Trust,
Blackshaw Road, London SW17 0QT, United Kingdom
(Rosano) Department of Medical Sciences IRCCS San Raffaele, Via della
Pisana, 235, Rome 00163, Italy
(Lopez-Sendon) Cardiology Department, Hospital Universitario la Paz,
IdiPaz, Paseo de la Castellana 261, Madrid 28036, Spain
Title
Expert consensus document: A 'diamond' approach to personalized treatment
of angina.
Source
Nature Reviews Cardiology. 15 (2) (pp 120-132), 2018. Date of Publication:
01 Feb 2018.
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
In clinical guidelines, drugs for symptomatic angina are classified as
being first choice (beta-blockers, calcium-channel blockers, short-acting
nitrates) or second choice (ivabradine, nicorandil, ranolazine,
trimetazidine), with the recommendation to reserve second-choice
medications for patients who have contraindications to first-choice
agents, do not tolerate them, or remain symptomatic. No direct comparisons
between first-choice and second-choice treatments have demonstrated the
superiority of one group of drugs over the other. Meta-analyses show that
all antianginal drugs have similar efficacy in reducing symptoms, but
provide no evidence for improvement in survival. The newer, second-choice
drugs have more evidence-based clinical data that are more contemporary
than is available for traditional first-choice drugs. Considering some
drugs, but not others, to be first choice is, therefore, difficult.
Moreover, double or triple therapy is often needed to control angina.
Patients with angina can have several comorbidities, and symptoms can
result from various underlying pathophysiologies. Some agents, in addition
to having antianginal effects, have properties that could be useful
depending on the comorbidities present and the mechanisms of angina, but
the guidelines do not provide recommendations on the optimal combinations
of drugs. In this Consensus Statement, we propose an individualized
approach to angina treatment, which takes into consideration the patient,
their comorbidities, and the underlying mechanism of
disease.<br/>Copyright &#xa9; 2018 Macmillan Publishers Limited, part of
Springer Nature. All rights reserved.

<2>
Accession Number
620386181
Author
Saadah N.; Wood E.; Bailey M.; Cooper D.J.; French C.; McQuilten Z.
Institution
(Saadah) Transfusion Research Unit, Monash University, Melbourne,
Australia
(Wood, Bailey, Cooper, McQuilten) Australian and New Zealand Intensive
Care Research Center, Monash University, Melbourne, Australia
(French) Intensive Care Unit, Western Health, Melbourne, Australia
Title
No association between age of transfused red cells and 30-day mortality in
massively transfused patients: Results from the australian and new zealand
massive transfusion registry.
Source
Blood. Conference: 59th Annual Meeting of the American Society of
Hematology, ASH 2017. United States. 130 (Supplement 1) (no pagination),
2017. Date of Publication: December 2017.
Publisher
American Society of Hematology
Abstract
Background: Clinical trials studying age of transfused red blood cells
(RBCs) have found no evidence of benefit from transfusion of fresher RBCs.
However, these studies have not included patients requiring massive
transfusion for major bleeding, A patient population that may be more
susceptible to adverse effects of the RBC storage lesion. Further, no
clinical trials have specifically evaluated the safety of transfusing RBCs
approaching expiry (30-42 days). We investigated the association between
RBC storage time and 30-day mortality in A large cohort of massively
transfused patients (5 RBCs within 4 hours, from any bleeding context).
Methods: Using 2007-2015 Australian/NZ Massive Transfusion Registry data
from 25 hospitals linked with Australian and New Zealand National Death
Index data, we modelled the association between storage time and 30-day
mortality in massively transfused patients. Our logistic regression model
adjusted for Charlson co-morbidity score, patient age, patient sex, number
of RBC units transfused, and bleeding category (cardiothoracic,
gastrointestinal, obstetric, surgical, trauma, vascular surgery, or other)
with treating hospital as A random-effects grouping variable. Storage time
was quantified as the mean storage time of all units each patient received
for our primary analysis, and as A binary predictor indicating patients
receiving only RBCs older than 30 days for our secondary analysis. As
sensitivity analyses, we stratified patients by number of RBC units
received and ran our model individually on each stratum containing more
than 50 patients receiving equivalent numbers of RBCs in order to
eliminate any confounding introduced by comparing patients receiving
differing numbers of RBCs. In our stratified sensitivity analyses, in
addition to mean storage time of RBC units received by each patient, we
tested minimum and maximum storage times of transfused RBC units as
predictors. Results: 4127 patients meeting the massive transfusion
definition during the study period had RBC age available. Stratifying on
number of RBC units transfused resulted in 19 strata containing more than
50 patients (those receiving 5,6,7,.23 RBC units), comprising 3641
patients (88% of study population). In the analysis of the entire cohort
together, we found no significant association between mean storage
duration and 30-day mortality (OR<inf>ST</inf>=0.99 [95%CI: 0.98 to 1.01];
p=0.42) or patients transfused with only RBCs >30days old and 30-day
mortality (OR<inf>ST>30d</inf>=0.85 [95%CI: 0.52 to 1.37]; p=0.49). In our
stratified sensitivity analyses, we found no association between mean
storage time and 30-day mortality (OR for A 1-day increase in mean storage
time [OR<inf>meanST</inf>] range = 0.95 to 1.08 with p>0.05 for entire
range). We likewise found no associations between maximum and minimum
storage times and 30-day mortality (OR<inf>maxST</inf> range = 0.93 to
1.05 with p>0.05 for all but one stratum; OR<inf>minST</inf> range = 0.94
to 1.04 with p>0.05 for all strata). For all three stratified sensitivity
analyses, we observed no trend in OR<inf>ST</inf> across the strata of
patients receiving equivalent numbers of RBCs (figure 1 shows the
stratified analysis with mean storage time as the predictor). Conclusions:
We found no association between storage time of transfused RBCs and 30-day
mortality in A large cohort of massively transfused patients. Our findings
were consistent both for the cohort as A whole and within strata of
patients receiving equivalent numbers of RBC transfusions. Additionally,
we observed no association when we modelled storage duration as maximum
RBC age, minimum RBC age, or when we considered patients receiving only
RBCs >30 days old. Our conclusions are consistent with recent large
randomised trials which have not demonstrated mortality benefit from
transfusing fresher RBCs. Differences in our findings and those of
previous observational studies reporting correlations between storage time
and mortality may be due to methodological differences: specifically, our
stratified analysis eliminated the potential confounding effect of number
of RBCs transfused, and we more accurately modelled the storage lesion as
A continuous function by using mean storage age rather than comparing
patients who received only RBCs above or below arbitrary storage time
thresholds. In conclusion, we find no evidence that fresher blood leads to
better clinical outcomes in massively transfused patients.

<3>
Accession Number
620384760
Author
Bitar S.E.; Moussaly E.; Abbasi S.; Ghanem S.; Nazha B.; Garcia G.;
Terjanian T.
Institution
(Bitar, Abbasi, Ghanem) Internal Medicine Department, Hofstra University
Northwell Health Staten Island, Staten Island, NY, United States
(Moussaly) Hematology Oncology Department, Cooper University Hospital,
Camden, NJ, United States
(Nazha) Hematology and Oncology, Emory University Hospital, Atlanta, GA,
United States
(Garcia) Hematology and Oncology Department, Hofstra University Northwell
Health Staten Island, Staten Island, NY, United States
(Terjanian) Hematology and Oncology Department, Siuh-Nalitt Institute for
Cancer and Blood-Related Diseases, Staten Island, NY, United States
Title
Heparin-induced thrombocytopenia: Are we ordering too much.
Source
Blood. Conference: 59th Annual Meeting of the American Society of
Hematology, ASH 2017. United States. 130 (Supplement 1) (no pagination),
2017. Date of Publication: December 2017.
Publisher
American Society of Hematology
Abstract
Introduction: Heparin induced thrombocytopenia (HIT) is a well described
cause of IGG antibody mediated platelet consumption.Over-testing for HIT
is highly prevalent in the hospital setting. Physicians' fear of missing
the diagnosis might contribute to these findings, despite the high
negative predictive value of the 4 T probability score and the HIT Expert
Probability (HEP) score. Also initiation of HIT treatment pending
confirmatory testing, results in a subsequent increase of costs and
exposure of patients to the unnecessary risks of anticoagulation. The aim
of our study is to identify clinical and laboratory factors that might
affect the decision of testing for HIT in the setting of low or
intermediate pretest probability and to prove that this entity is
over-investigated and over-treated in the in-hospital environment.
Methods: We conducted a cross-sectional retrospective observational study
at Hofstra University Northwell Health Staten Island Hospital. Inclusion
criteria were patients 18 years and older who had undergone
anti-PF4-heparin antibody testing on an inpatient basis, from January 2013
till August 2015. Patients were excluded only if the test was done as
outpatient. Statistical analysis was conducted using independent-sample
T-test, Chi-square test or Fisher's exact test. All statistical tests were
2-sided and conducted at the 0.05 level of significance. Data was analyzed
using the SAS System Version 9.3 (SAS Institute Inc., Cary, NC). Results:
Data was collected on 89 patients who underwent anti-PF4-heparin antibody
testing. 84 patients (94%) underwent HIT testing with a low 4 T score as
compared to 5 patients (6%) with a high 4 T score. There was no
significant difference in the proportion of testing with respect to gender
age, the service under which the patient was admitted (medicine vs.
surgery), presence of a hematology consult, a history of cardiac surgery,
type of heparin used and an elevated Charleson score. 80% (n=74) of
patients had another cause for thrombocytopenia and had the HIT panel
ordered despite a low/intermediate 4T score (Table 1). In our study, 5
patients tested positive for HIT. 3 of the patients had high 4 T and HEP
score pretest probability while 2 of the patients had intermediate 4 T
score and high HEP score pretest probability. All 60 patients with a low 4
T score tested negative for HIT (Table 2). After ordering HIT serology,
heparin was discontinued in 82 patients. 17 patients with low/intermediate
4T score were started on anticoagulation, 2 of them had new bleeding
event. 6 patient with high 4 T score were started on anticoagulation and 1
of them had a bleeding event (Table 3). Conclusion: HIT poses a
significant diagnostic challenge. It is an uncommon cause of
thrombocytopenia that carries significant morbidity and mortality. Our
study showed that HIT testing using ELISA immunoassays is being ordered
excessively in the setting of low to intermediate pretest probability
leading to unwarranted treatments at significant costs and carrying an
important burden on the healthcare system. However, a high number of
comorbidities did not seem to lower the threshold for ordering HIT panel.
It is very challenging to conduct randomized trials on less common
diseases in the clinical setting to improve test ordering practices. The
HEP score might be an important adjunct to clinical decision making in the
future but this requires more studies being conducted.

<4>
Accession Number
620375030
Author
Friedman D.J.; Piccini J.P.; Wang T.; Zheng J.; Malaisrie S.C.; Holmes
D.R.; Suri R.M.; Mack M.J.; Badhwar V.; Jacobs J.P.; Gaca J.G.; Chow
S.-C.; Peterson E.D.; Brennan J.M.
Institution
(Brennan) Division of Cardiology, Duke University School of Medicine, 2400
Pratt St, Room 0311 Terrace Level, Durham, NC 27705, United States
(Friedman, Piccini, Peterson) Duke Clinical Research Institute, Durham,
NC, United States
(Friedman, Piccini, Peterson, Brennan) Duke University School of Medicine,
Durham, NC, United States
(Wang, Zheng, Chow) Department of Biostatistics and Bioinformatics, Duke
University, Durham, NC, United States
(Malaisrie) Division of Cardiac Surgery, Northwestern University, Chicago,
IL, United States
(Holmes) Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN,
United States
(Suri) Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation,
Cleveland, OH, United States
(Mack) Division of Cardiovascular Surgery, Baylor University, Dallas, TX,
United States
(Badhwar) Department of Cardiovascular and Thoracic Surgery, West Virginia
University, Morgantown, United States
(Jacobs) Hopkins All Children's Heart Institute, StPetersburg, FL, United
States
(Gaca) Division of Cardiovascular and Thoracic Surgery, Duke University,
Durham, NC, United States
Title
Association Between Left Atrial Appendage Occlusion and Readmission for
Thromboembolism Among Patients With Atrial Fibrillation Undergoing
Concomitant Cardiac Surgery.
Source
JAMA - Journal of the American Medical Association. 319 (4) (pp 365-374),
2018. Date of Publication: 23 Jan 2018.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE The left atrial appendage is a key site of thrombus formation
in atrial fibrillation (AF) and can be occluded or removed at the time of
cardiac surgery. There is limited evidence regarding the effectiveness of
surgical left atrial appendage occlusion (S-LAAO) for reducing the risk of
thromboembolism. OBJECTIVE To evaluate the association of S-LAAO vs no
receipt of S-LAAO with the risk of thromboembolism among older patients
undergoing cardiac surgery. DESIGN, SETTING, AND PARTICIPANTS
Retrospective cohort study of a nationally representative Medicare-linked
cohort from the Society of Thoracic Surgeons Adult Cardiac Surgery
Database (2011-2012). Patients aged 65 years and older with AF undergoing
cardiac surgery (coronary artery bypass grafting [CABG], mitral valve
surgery with or without CABG, or aortic valve surgery with or without
CABG) with and without concomitant S-LAAO were followed up until December
31, 2014. EXPOSURES S-LAAO vs no S-LAAO. MAIN OUTCOMES AND MEASURES The
primary outcome was readmission for thromboembolism (stroke, transient
ischemic attack, or systemic embolism) at up to 3 years of follow-up, as
defined by Medicare claims data. Secondary end points included hemorrhagic
stroke, all-cause mortality, and a composite end point (thromboembolism,
hemorrhagic stroke, or all-cause mortality). RESULTS Among 10 524 patients
undergoing surgery (median age, 76 years; 39% female; median
CHA<inf>2</inf>DS<inf>2</inf>-VASc score, 4), 3892 (37%) underwent S-LAAO.
Overall, at a mean follow-up of 2.6 years, thromboembolism occurred in
5.4%, hemorrhagic stroke in 0.9%, all-cause mortality in 21.5%, and the
composite end point in 25.7%. S-LAAO, compared with no S-LAAO, was
associated with lower unadjusted rates of thromboembolism (4.2% vs 6.2%),
all-cause mortality (17.3% vs 23.9%), and the composite end point (20.5%
vs 28.7%) but no significant difference in rates of hemorrhagic stroke
(0.9% vs 0.9%). After inverse probability-weighted adjustment, S-LAAO was
associated with a significantly lower rate of thromboembolism
(subdistribution hazard ratio [HR], 0.67; 95% CI, 0.56-0.81; P < .001),
all-cause mortality (HR, 0.88; 95% CI, 0.79-0.97; P = .001), and the
composite end point (HR, 0.83; 95% CI, 0.76-0.91; P < .001) but not
hemorrhagic stroke (subdistribution HR, 0.84; 95% CI, 0.53-1.32; P = .44).
S-LAAO, compared with no S-LAAO, was associated with a lower risk of
thromboembolism among patients discharged without anticoagulation
(unadjusted rate, 4.2% vs 6.0%; adjusted subdistribution HR, 0.26; 95% CI,
0.17-0.40; P < .001), but not among patients discharged with
anticoagulation (unadjusted rate, 4.1% vs 6.3%; adjusted subdistribution
HR, 0.88; 95% CI, 0.56-1.39; P = .59). CONCLUSIONS AND RELEVANCE Among
older patients with AF undergoing concomitant cardiac surgery, S-LAAO,
compared with no S-LAAO, was associated with a lower risk of readmission
for thromboembolism over 3 years. These findings support the use of
S-LAAO, but randomized trials are necessary to provide definitive
evidence.<br/>Copyright &#xa9; 2018 American Medical Association. All
rights reserved.

<5>
Accession Number
620353172
Author
Schumann J.; Henrich E.C.; Strobl H.; Prondzinsky R.; Weiche S.; Thiele
H.; Werdan K.; Frantz S.; Unverzagt S.
Institution
(Schumann) Martin-Luther-University Halle-Wittenberg, Department of
Anaesthesiology and Surgical Intensive Care, Halle/Saale, Germany
(Henrich, Strobl, Unverzagt) Martin-Luther-University Halle-Wittenberg,
Institute of Medical Epidemiology, Biostatistics and Informatics,
Halle/Saale 06112, Germany
(Prondzinsky) Carl von Basedow Klinikum Merseburg, Cardiology/Intensive
Care Medicine, Weisse Mauer 42, Merseburg 06217, Germany
(Weiche, Werdan, Frantz) Martin-Luther-University Halle-Wittenberg,
Department of Internal Medicine III, Halle/Saale, Germany
(Thiele) University Clinic Schleswig-Holstein, Campus Lubeck, Medical
Clinic II (Kardiology, Angiology, Intensive Care Medicine), Ratzeburger
Allee 160, Lubeck D-23538, Germany
Title
Inotropic agents and vasodilator strategies for the treatment of
cardiogenic shock or low cardiac output syndrome.
Source
Cochrane Database of Systematic Reviews. 2018 (1) (no pagination), 2018.
Article Number: CD009669. Date of Publication: 29 Jan 2018.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Cardiogenic shock (CS) and low cardiac output syndrome (LCOS)
as complications of acute myocardial infarction (AMI), heart failure (HF)
or cardiac surgery are life-threatening conditions. While there is a broad
body of evidence for the treatment of people with acute coronary syndrome
under stable haemodynamic conditions, the treatment strategies for people
who become haemodynamically unstable or develop CS remain less clear. We
have therefore summarised here the evidence on the treatment of people
with CS or LCOS with different inotropic agents and vasodilative drugs.
This is the first update of a Cochrane review originally published in
2014. Objectives: To assess efficacy and safety of cardiac care with
positive inotropic agents and vasodilator strategies in people with CS or
LCOS due to AMI, HF or cardiac surgery. Search methods: We searched
CENTRAL, MEDLINE, Embase and CPCI-S Web of Science in June 2017. We also
searched four registers of ongoing trials and scanned reference lists and
contacted experts in the field to obtain further information. No language
restrictions were applied. Selection criteria: Randomised controlled
trials in people with myocardial infarction, heart failure or cardiac
surgery complicated by cardiogenic shock or LCOS. Data collection and
analysis: We used standard methodological procedures expected by Cochrane.
Main results: We identified 13 eligible studies with 2001 participants
(mean or median age range 58 to 73 years) and two ongoing studies. We
categorised studies into eight comparisons, all against cardiac care and
additional other active drugs or placebo. These comparisons investigated
the efficacy of levosimendan versus dobutamine, enoximone or placebo,
epinephrine versus norepinephrine-dobutamine, amrinone versus dobutamine,
dopexamine versus dopamine, enoximone versus dopamine and nitric oxide
versus placebo. All trials were published in peer-reviewed journals, and
analysis was done by the intention-to-treat (ITT) principle. Twelve of 13
trials were small with few included participants. Acknowledgement of
funding by the pharmaceutical industry or missing conflict of interest
statements emerged in five of 13 trials. In general, confidence in the
results of analysed studies was reduced due to serious study limitations,
very serious imprecision or indirectness. Domains of concern, which show a
high risk of more than 50%, include performance bias (blinding of
participants and personnel) and bias affecting the quality of evidence on
adverse events. Levosimendan may reduce short-term mortality compared to a
therapy with dobutamine (RR 0.60, 95% CI 0.37 to 0.95; 6 studies; 1776
participants; low-quality evidence; NNT: 16 (patients with moderate risk),
NNT: 5 (patients with CS)). This initial short-term survival benefit with
levosimendan vs. dobutamine is not confirmed on long-term follow up. There
is uncertainty (due to lack of statistical power) as to the effect of
levosimendan compared to therapy with placebo (RR 0.48, 95% CI 0.12 to
1.94; 2 studies; 55 participants, very low-quality evidence) or enoximone
(RR 0.50, 95% CI 0.22 to 1.14; 1 study; 32 participants, very low-quality
evidence). All comparisons comparing other positive inotropic, inodilative
or vasodilative drugs presented uncertainty on their effect on short-term
mortality with very low-quality evidence and based on only one RCT. These
single studies compared epinephrine with norepinephrine-dobutamine (RR
1.25, 95% CI 0.41 to 3.77; 30 participants), amrinone with dobutamine (RR
0.33, 95% CI 0.04 to 2.85; 30 participants), dopexamine with dopamine (no
in-hospital deaths from 70 participants), enoximone with dobutamine (two
deaths from 40 participants) and nitric oxide with placebo (one death from
three participants). Authors' conclusions: Apart from low quality of
evidence data suggesting a short-term mortality benefit of levosimendan
compared with dobutamine, at present there are no robust and convincing
data to support a distinct inotropic or vasodilator drug-based therapy as
a superior solution to reduce mortality in haemodynamically unstable
people with cardiogenic shock or LCOS. Considering the limited evidence
derived from the present data due to a generally high risk of bias and
imprecision, it should be emphasised that there remains a great need for
large, well-designed randomised trials on this topic to close the gap
between daily practice in critical care medicine and the available
evidence. It seems to be useful to apply the concept of 'early
goal-directed therapy' in cardiogenic shock and LCOS with early
haemodynamic stabilisation within predefined timelines. Future clinical
trials should therefore investigate whether such a therapeutic concept
would influence survival rates much more than looking for the 'best' drug
for haemodynamic support.<br/>Copyright &#xa9; 2018 The Cochrane
Collaboration. Published by John Wiley & Sons, Ltd.

<6>
Accession Number
620383465
Author
Kverneland L.S.; Kramer P.; Ovroutski S.
Institution
(Kverneland) Department of Internal MedicineHerlev HospitalCopenhagen
Denmark
(Kverneland, Kramer, Ovroutski) Department of Congenital Heart
Disease/Pediatric CardiologyGerman Heart Center BerlinBerlin Germany
Title
Five decades of the Fontan operation: A systematic review of international
reports on outcomes after univentricular palliation.
Source
Congenital Heart Disease. (no pagination), 2018. Date of Publication:
2018.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Almost fifty years after its first clinical application, the modified
Fontan operation is among the most frequently performed procedures in
congenital heart disease surgery in children today. The objective of this
review is to systematically summarize the international evolution of
outcomes in regard to morbidity and mortality of patients with Fontan
palliation. All studies published over the past five decades with more
than 100 Fontan patients included were screened. In eligible studies,
information concerning preoperative patients' characteristics, Fontan
modifications employed, early mortality, long-term survival and frequency
of relevant complications was extracted. Ultimately, thirty-one studies
published by the largest surgical centers with an overall number of 9390
patients were included in this review. The extracardiac total
cavopulmonary anastomosis is the most frequently used Fontan modification.
Hemodynamic data demonstrate a rigorous overall adherence to suggested
Fontan selection criteria. The analysis showed a clear trend toward
improved early and long-term survival over the time period covered.
Although inconsistently reported, severe complications such as
arrhythmias, thromboembolic events and protein-losing enteropathy as well
as reoperations and reinterventions were frequent. In conclusion, patients
palliated for complex univentricular heart malformations nowadays benefit
from the experience and technical developments of the past decades and
have a significantly improved long-term prognosis. However, important
issues concerning postoperative long-term morbidity and mortality are
still unsolved and clear intrinsic limitations of the Fontan circulation
are becoming evident as the population of Fontan patients
ages.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<7>
Accession Number
617936119
Author
Chen X.; Huang T.; Cao X.; Xu G.
Institution
(Chen, Cao) Grade 2013, The Second Clinical Medical College of Nanchang
University, Nanchang, Jiangxi, China
(Huang, Xu) Department of Nephrology, The Second Affiliated Hospital of
Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, Jiangxi
330006, China
Title
Comparative Efficacy of Drugs for Preventing Acute Kidney Injury after
Cardiac Surgery: A Network Meta-Analysis.
Source
American Journal of Cardiovascular Drugs. 18 (1) (pp 49-58), 2018. Date of
Publication: 01 Feb 2018.
Publisher
Springer International Publishing
Abstract
Background: Acute kidney injury (AKI) occurs frequently after cardiac
surgery and has been associated with increased hospital length of stay,
mortality, and costs. Objective: We aimed to evaluate the efficacy of
pharmacologic strategies for preventing AKI after cardiac surgery.
Methods: We searched PubMed, Embase, the Cochrane Central Register of
Controlled Trials (CENTRAL) up to 6 May 2017 and the reference lists of
relevant articles about trials. The outcome was the occurrence of AKI.
This is the first network meta-analysis of the different prevention
strategies using Bayesian methodology. Results: The study included 63
articles with 19,520 participants and evaluated the effect of ten
pharmacologic strategies to prevent AKI in patients undergoing cardiac
surgery. Compared with placebo, the odds ratio (OR) for the occurrence of
AKI was 0.24 [95% confidence interval (CI) 0.16-0.34] with natriuretic
peptide, 0.33 (95% CI 0.14-0.70) with fenoldopam, 0.54 (95% CI 0.31-0.84)
with dexmedetomidine, 0.56 (95% CI 0.29-0.95) with low-dose
erythropoietin, 0.63 (95% CI 0.43-0.88) with levosimendan, 0.76 (95% CI
0.52-1.10) with steroids, 0.83 (95% CI 0.48-1.40) with high-dose
erythropoietin, 0.85 (95% CI 0.64-1.14) with N-acetylcysteine, 0.96 (95%
CI 0.69-1.29) with sodium bicarbonate, and 1.05 (95% CI 0.70-1.41) with
statins. The surface under the cumulative ranking curve probabilities
indicated that natriuretic peptide was the best treatment therapy and that
fenoldopam ranked second. Conclusions: Natriuretic peptide is probably the
preferred pharmacologic strategy to prevent AKI in adult patients
undergoing cardiac surgery, especially in those at high risk of
AKI.<br/>Copyright &#xa9; 2017, Springer International Publishing AG.

<8>
Accession Number
620117342
Author
Szymanski F.M.; Galazka Z.; Platek A.E.; Gorko D.; Ostrowski T.;
Adamkiewicz K.; Legosz P.; Rys A.; Semczuk-Kaczmarek K.; Celejewski K.;
Filipiak K.J.
Institution
(Szymanski, Platek, Adamkiewicz, Rys, Semczuk-Kaczmarek, Filipiak) 1st
Department of Cardiology, Medical University of Warsaw, ul. Banacha 1A,
Warszawa 02-097, Poland
(Galazka, Gorko, Ostrowski, Celejewski) Department of General and
Endocrinological Surgery, Medical University of Warsaw, Warsaw, Poland
(Platek) Department of General and Experimental Pathology, Centre for
Preclinical Research and Technology (CEPT), Medical University of Warsaw,
Warsaw, Poland
(Gorko) Cardiology Department, Regional Hospital, Kolobrzeg, Poland
(Legosz) Department of Orthopaedics and Traumatology, Medical University
of Warsaw, Warsaw, Poland
Title
Peripheral A Rtery Atherosclerotic DIsease and Sleep disordered breathing
(PARADISE) trial-protocol for an observational cohort study.
Source
Kardiologia Polska. 75 (12) (pp 1332-1338), 2017. Date of Publication: 15
Dec 2017.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: Peripheral arterial disease (PAD) is in fact a group of
disease entities with different symptoms and course but a common
underlying cause, i.e. atherosclerosis. Atherosclerosis is known to be
aggravated by several cardiovascular risk factors, including obstructive
sleep apnoea (OSA). Aim: Following paper is a protocol for the Peripheral
ARtery Atherosclerotic DIsease and SlEep disordered breathing (PARADISE)
trial, which aims to describe the prevalence of OSA in PAD patients
scheduled for revascularisation, and to determine the effect of OSA on the
procedure outcomes. Methods: The PARADISE study is an observational cohort
trial. It plans to include 200 consecutive patients hospitalised for
revascularisation due to PAD. In every patient an overnight sleep study
will be performed to diagnose sleep disorders. According to the results of
the test, patients will be divided into two groups: Group A - patients
with OSA, and group B - patients without OSA (control group). All patients
will also be screened for classical and non-classical cardiovascular risk
factors. In some of the patients, during surgery, a fragment of
atherosclerotic plaque will be collected for further testing. Patients
will be followed for one year for adverse events and end-points. Primary
end-point of the study will be the failure of revascularisation defined as
recurrence or new onset of the symptoms of ischaemia from the treated
region, a need for re-operation or procedure revision, or recurrence of
ischaemia signs on the imaging tests. Discussion: The data obtained will
help determine the incidence of OSA in the population of patients with
PAD. The authors expect to show that, as with other cardiovascular
diseases associated with atherosclerosis, also in patients with PAD the
incidence of undiagnosed OSA is high and its presence is associated with
elevated cholesterol, inflammatory markers, and higher prevalence of
arterial hypertension and poor control of other cardiovascular risk
factors. In addition, due to increased oxidative stress and vascular
endothelial injury associated with OSA, patients afflicted with this
condition will not only have more advanced atherosclerotic lesions, but
also in their histopathological examination their atherosclerotic plaque
will exhibit evidence of greater instability and adverse morphology. We
also expect to show that in patients with OSA, achieving correct control
of cardiovascular risk factors will be more difficult. The study may
improve PAD control through assuring better multispecialty care in PAD
patients.<br/>Copyright &#xa9; Polskie Towarzystwo Kardiologiczne 2017.

<9>
[Use Link to view the full text]
Accession Number
620282224
Author
Bundhun P.K.; Gupta C.; Huang F.
Institution
(Bundhun) Institute of Cardiovascular Diseases, First Affiliated Hospital
of Guangxi Medical University, China
(Gupta) Guangxi Medical University, China
(Huang) Institute of Cardiovascular Diseases and Guangxi Key Laboratory
Base of Precision Medicine, Cardio-cerebrovascular Diseases Control and
Prevention, First Affiliated Hospital of Guangxi Medical University,
Nanning, Guangxi 530021, China
Title
Should fraction flow reserve be considered an important decision-making
tool to stratify patients with stable coronary artery disease for
percutaneous coronary intervention?: A meta-analysis.
Source
Medicine (United States). 96 (46) (no pagination), 2017. Article Number:
e8748. Date of Publication: November 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Nowadays, fraction flow reserve (FFR) is being discussed in
every percutaneous coronary intervention (PCI) capable hospitals. Owing to
recent development in the medical field, FFR-guided PCI should be able to
find a place in Interventional Cardiology. At present, the importance of
FFR to stratify patients who require PCI has seldom systematically been
investigated. In this analysis, we aimed to compare the major adverse
cardiac events (MACEs) mainly in patients with stable coronary artery
disease (CAD) to whom PCI was recommended and deferred respectively based
on the FFR value. Methods: Electronic databases were searched for studies
comparing FFR-recommended versus FFR-deferred coronary stenting. Long-term
MACEs, mortality, and myocardial infarction (MI) were considered as the
clinical endpoints in this analysis. Odds ratios (ORs) with 95% confidence
intervals (CIs) were calculated and the analyses were carried out by the
latest version of the RevMan software. Results: A total number of 1753
patients (670 patients were revascularized, whereas 1083 patients were
deferred from revascularization based on the FFR value) were analyzed.
Current results showed MACEs and MI were significantly higher in the
FFRrecommended PCI group with OR 1.34 (95% CI: 1.05-1.72; P=.02) and OR
1.73 (95% CI: 1.19-2.51; P=.004, I²=0%), respectively. However,
mortality was similarly manifested with OR 1.23 (95% CI: 0.92-1.63; P=.16,
I²=0%). Conclusion: Significantly higher MACEs were observed in
patients to whom PCI was recommended compared to those patients who were
deferred from undergoing PCI based on the FFR values. Therefore, FFR might
indeed be an important decision-making procedural tool, which should be
used to stratify stable CAD patients with an advanced disease and who are
qualified candidates for PCI. Further research should confirm this
hypothesis. Abbreviations: FFR = fraction flow reserve, MACEs = major
adverse cardiac events, MI = myocardial infarction, PCI = percutaneous
coronary intervention.<br/>Copyright &#xa9; 2017 the Author(s).

<10>
Accession Number
613566794
Author
Baker W.L.; Coleman C.I.
Institution
(Baker, Coleman) Department of Pharmacy Practice, School of Pharmacy,
University of Connecticut, Storrs, CT, United States
Title
Meta-analysis of ascorbic acid for prevention of postoperative atrial
fibrillation after cardiac surgery.
Source
American Journal of Health-System Pharmacy. 73 (24) (pp 2056-2066), 2016.
Date of Publication: 15 Dec 2016.
Publisher
American Society of Health-Systems Pharmacy
Abstract
Purpose. Results of a systematic review and meta-analysis of published
data on use of ascorbic acid to prevent postoperative atrial fibrillation
(POAF) after cardiac surgery are presented. Methods. MEDLINE and other
sources were searched for reports on trials evaluating the effects of
preoperative and/or postoperative use of ascorbic acid in patients
undergoing cardiac surgery. For each study selected for meta-analysis, an
assessment for risks of methodological bias was performed. Data on POAF
frequency and length of stay (LOS) outcomes were pooled and analyzed via
random-effects modeling. Results. The 11 identified studies involved
patients receiving coronary artery bypass grafts with or without valve
replacement; both i.v. and oral ascorbic acid formulations were used.
Analysis of pooled outcomes data on treatment and control groups indicated
that ascorbic acid prophylaxis was associated with reductions in POAF
frequency (odds ratio, 0.44; 95% confidence interval [CI], 0.32 to 0.61),
intensive care unit (ICU) LOS (difference in means, -0.24 day; 95% CI,
-0.45 to -0.03 day), and total hospital LOS (difference in means, -0.94
day; 95% CI, -1.65 to -0.23 day). Significant statistical, methodological,
and clinical heterogeneity were observed. Conclusion. A meta-analysis
revealed that, compared with use of a placebo or a nonplacebo control,
perioperative administration of ascorbic acid to patients undergoing
cardiac surgery was associated with a reduced frequency of POAF and a
shorter ICU LOS and total hospital LOS.<br/>&#xa9; Copyright 2016,
American Society of Health-System Pharmacists, Inc. All rights.

<11>
[Use Link to view the full text]
Accession Number
610495433
Author
Basciani R.M.; Rindlisbacher A.; Begert E.; Brander L.; Jakob S.M.; Etter
R.; Carrel T.; Eberle B.
Institution
(Basciani, Eberle) Department of Anesthesiology and Pain Medicine,
University Hospital, University of Bern, Bern, Switzerland
(Rindlisbacher, Begert, Brander, Jakob, Etter) Department of Intensive
Care Medicine, University Hospital, University of Bern, Inselspital,
Freiburgstrasse, Bern CH-3010, Switzerland
(Carrel) Department of Cardiovascular Surgery, University Hospital,
University of Bern, Bern, Switzerland
(Brander) Department of Anesthesia, Cantonal Hospital, Lucerne,
Switzerland
Title
Anaesthetic induction with etomidate in cardiac surgery.
Source
European Journal of Anaesthesiology. 33 (6) (pp 417-424), 2016. Date of
Publication: 01 Jun 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND Etomidate is perceived as preserving haemodynamic stability
during induction of anaesthesia. It is also associated with adrenocortical
dysfunction. The risk/benefit relationship is controversial. OBJECTIVES We
tested the hypotheses that single-dose etomidate increases cumulative
vasopressor requirement, time to extubation and length of stay in the ICU.
DESIGN Double-blind randomised controlled trial. SETTING Bern University
Hospital, Switzerland, from November 2006 to December 2009. PATIENTS There
were 90 patients undergoing coronary artery bypass grafts (CABG) and 40
patients undergoing mitral valve surgery (MVS). Reasons for noninclusion
were known adrenocortical insufficiency, use of etomidate or propofol
within 1 week preoperatively, use of glucocorticoids within 6 months
preoperatively, severe renal or liver dysfunction, or carotid stenosis.
INTERVENTIONS CABG patients were allocated randomly to receive either
etomidate 0.15mgkg -1 with placebo, propofol 1.5mgkg -1 with placebo or
etomidate 0.15mgkg -1 with hydrocortisone (n=30 in each arm). Risk
stratification (low vs. high) was achieved by block randomisation. MVS
patients received either etomidate 0.15mgkg -1 or propofol 1.5mgkg -1
(n=20 in each arm). MAIN OUTCOME MEASURES Cumulative vasopressor
requirements, incidence of adrenocortical insufficiency, length of time to
extubation and length of stay in ICU. RESULTS Cumulative vasopressor
requirements 24h after induction did not differ between treatments in
patients who underwent CABG, whereas more noradrenaline was used in MVS
patients following propofol induction (absolute mean difference 5.86mugkg
-1 over 24h P=0.047). The incidence of relative adrenocortical
insufficiency was higher after etomidate alone than propofol (CABG 83 vs.
37%, P<0.001; MVS: 95 vs. 35%, P<0.001). The time to extubation, length of
stay in ICU and 30-day mortality did not differ among treatments. Within
low and high-risk subgroups, no differences in vasopressor use or outcomes
were found. CONCLUSION In elective cardiac surgery, laboratory indicators
of etomidate-induced adrenal insufficiency do not translate into increased
vasopressor requirement or inferior early outcomes. TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT 00415701.<br/>Copyright &#xa9; 2016
European Society of Anaesthesiology. All rights reserved.

<12>
[Use Link to view the full text]
Accession Number
610495425
Author
Haas E.; Fischer F.; Levy F.; Degirmenci S.-E.; Grunebaum L.; Kindo M.;
Collange O.; Mertes P.-M.; Steib A.
Institution
(Haas, Fischer, Levy, Degirmenci, Collange, Mertes, Steib) Department of
Anaesthesiology, Strasbourg University Hospital, France
(Grunebaum) Department of Haematology, United Kingdom
(Kindo) Department of Cardiovascular Surgery, Strasbourg University
Hospital, France
Title
Identifying optimal heparin management during cardiopulmonary bypass in
obese patients.
Source
European Journal of Anaesthesiology. 33 (6) (pp 408-416), 2016. Date of
Publication: 01 Jun 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND The heparin regimen providing anticoagulation during
cardiopulmonary bypass (CPB) is usually adapted to total body weight
(TBW), but may be inaccurate in obese patients in whom TBW exceeds their
ideal body weight. OBJECTIVES The objective is to compare the effects of
heparin injection based on TBW on haemostatic parameters between obese and
nonobese patients during cardiac surgery and to calculate the optimal
heparin regimen. DESIGN Prospective comparative study. SETTING University
hospital. PATIENTS Two groups of 50 patients (BMI>= or <30kgm -2) were
included in the study over a 9-month period in 2013. The study started on
27 February 2013. INTERVENTIONS An unfractionated heparin (UFH) bolus of
300IUkg -1 TBW was injected before initiation of CPB followed by
additional doses (50 to 100IUkg -1) to maintain a target activated
coagulation time (ACT) of at least 400s. MAIN OUTCOME MEASURES ACT and
plasma heparin concentration were measured at different time points after
initiation of, and weaning from CPB. RESULTS Obese patients received
higher initial and total doses of heparin (P<0.0001). Plasma heparin
concentrations were significantly higher in obese patients at each time
point (P<0.001) and reached very high values after the initial bolus (5.90
vs. 4.48IUml -1, P<0.0001). The relationship between plasma heparin
concentration and ACT after the initial bolus was not linear and followed
an asymptotic regression curve. Haemoglobin concentration decreased
intraoperatively to a greater extent in the obese group (P<0.001). No
significant differences in postoperative bleeding or global transfusion
requirements were observed. CONCLUSION The standard heparin regimen based
on TBW in obese patients during CPB results in excessive plasma heparin
concentrations and a significant intraoperative decrease in haemoglobin
concentration. ACT monitoring was not accurate in identifying this excess
dosage. An initial bolus of 340IUkg -1 ideal body weight would achieve a
heparin concentration of 4.5IUml -1, similar to that observed in nonobese
patients. Further investigations are warranted to confirm this heparin
regimen.<br/>Copyright &#xa9; 2016 European Society of Anaesthesiology.
All rights reserved.

<13>
[Use Link to view the full text]
Accession Number
610495414
Author
Straarup T.S.; Hausenloy D.J.; Rolighed Larsen J.K.
Institution
(Straarup) Department of Anaesthesia, Aarhus University Hospital, Viborg,
Denmark
(Hausenloy) Hatter Cardiovascular Institute, University College London,
London, United Kingdom
(Rolighed Larsen) Institute of Clinical Medicine, Aarhus University
Hospital, Department of Anaesthesia, Viborg and Silkeborg, Denmark
Title
Cardiac troponins and volatile anaesthetics in coronary artery bypass
graft surgery.
Source
European Journal of Anaesthesiology. 33 (6) (pp 396-407), 2016. Date of
Publication: 01 Jun 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND Reports from animal studies indicate that volatile anaesthetics
protect the myocardium against the effects of acute ischaemia-reperfusion
injury by reducing infarct size. This cardioprotective effect in the
clinical setting of coronary artery bypass graft (CABG) surgery, where the
heart is subjected to global ischaemia-reperfusion injury, remains
controversial. OBJECTIVE The objective was to demonstrate that clinical
studies investigating the cardioprotective effect of volatile anaesthetics
on cardiac troponins in CABG are no longer warranted. We also investigated
the effect of volatile anaesthetics on cardiac enzymes in off-pump cardiac
surgery. DESIGN Systematic review of randomised clinical trials,
meta-analyses and trial sequential analysis (TSA). DATA SOURCES Trials
between January 1985 and March 2015 were obtained from electronic
databases (Medline, Excerpta Medica Database (EMBASE), Cochrane Controlled
Trial Register, abstracts from major anaesthesiology and cardiology
journals and reference lists of relevant randomised trials and review
articles. ELIGIBILITY CRITERIA Relevant randomised clinical trials were
included. We investigated the effect of volatile anaesthetics in both
off-pump and on-pump CABG surgery with respect to troponin release [peak
postoperative cardiac troponin I (cTnI) and cardiac troponin T (cTnT),
cTnI/cTnT] and performed two separate meta-analyses. TSA was used to
overcome the weakness of a type-1 error associated with repeated
meta-analyses. RESULTS From 30 studies, 2578 patients were pooled for the
meta-analysis. The outcome significantly favours the use of peroperative
volatile over non-volatile anaesthetics during on-pump CABG surgery with
regard to peak postoperative cTnI (0.995mgl -1; standard mean difference,
95% confidence interval, -1.316 to -0.673; P<0.001). Meta-analysis of 11
off-pump studies showed no difference in peak postoperative cTnI (0.385mgl
-1; standard mean difference, 95% confidence interval, -0.857 to 0.087;
P=0.11). TSA indicated that the required information size for on-pump
surgery was 1072 patients, and for off-pump surgery it was 1442; this
latter figure has not yet been reached. CONCLUSION Studies investigating
the cardioprotective effect of volatile anaesthetics on cardiac troponins
in on-pump CABG surgery are no longer warranted. This is not yet the case
for off-pump surgery.<br/>Copyright &#xa9; 2016 European Society of
Anaesthesiology. All rights reserved.

<14>
Accession Number
620354062
Author
Nasser L.; Ashworth A.; Singh N.; Stirling S.
Institution
(Nasser, Ashworth, Singh, Stirling) University Hospital of South
Manchester, United Kingdom
Title
Audit of patient readmissions to a tertiary cardiothoracic intensive care
unit 1 year after the introduction of a postoperative critical care
assessment team: Has it made a difference?.
Source
Anaesthesia. Conference: Winter Scientific Meeting of the Association of
Anaesthetists of Great Britain and Ireland, AAGBI WSM 2018. United
Kingdom. 73 (Supplement 2) (pp 34), 2018. Date of Publication: January
2018.
Publisher
Blackwell Publishing Ltd
Abstract
The Cardiothoracic Critical Care Unit (CTCCU) at the University Hospital
of South Manchester is a 31 bed mixed level 3/2 unit for tertiary
cardiothoracic surgical patients, heart/lung transplantation, respiratory
ECMO and mechanical circulatory support. The general ICU critical care
outreach service do not provide routine follow- up of patients discharged
from CTCCU. Methods In February 2016 we introduced the Critical Care
Assessment Team (CCAT) comprising 12 experienced CTCCU nurses. Their
primary aim is to conduct a thorough assessment of all patients discharged
from CTCCU to aid early detection, treatment and management of any
postoperative complications and to reduce/prevent readmission to critical
care. We audited patient follow up data from February 2016 to February
2017 to determine if the service is fulfilling its goals and, most
importantly, improving patient safety by reducing postoperative morbidity
and mortality. Results The mean number of patients reviewed per month was
129, with readmissions to CTCCU between 1 and 5 patients per month (mean
2.8). In the 6 months preceding the introduction of CCAT there were 23
readmissions, equating to a mean of 3.8 patient readmissions per month.
Discussion The results show there has been a reduction in the number of
readmissions to CTCCU since the introduction of the CCAT service.
Anecdotally it is clear that the critical care systematic review of
patients followed up on the ward has lead to early recognition and
management of postoperative complications. This is beneficial in
preventing readmission, but also facilitates prompt readmission if
required. The NICE guidelines for the transfer of critical care patients
to a ward setting state that while there should be shared responsibility
for the care of these patients, the critical care team should support the
receiving ward in delivering the ensuing care plan [1]. The service has
been shown to support ward staff in the management of these complex
surgical patients, as evidenced by a staff satisfaction questionnaire. Due
to the small number of patients it has not been possible to draw
conclusions on whether the CCAT service has had a long term impact on
patient morbidity and mortality [2]. Despite this, our figures show the
CCAT service has an important role to play in maintaining high standards
of postoperative patient care in a tertiary unit with such a high turnover
of cardiothoracic patients. (Figure Presented).

<15>
Accession Number
620353887
Author
Ingram A.; Harper M.
Institution
(Ingram) Xcelerate Health Outcomes, United Kingdom
(Harper) Royal Sussex County Hospital, United Kingdom
Title
The health economic benefits of perioperative patient warming for
prevention of blood loss and transfusion requirements as a consequence of
inadvertent peri-operative hypothermia.
Source
Anaesthesia. Conference: Winter Scientific Meeting of the Association of
Anaesthetists of Great Britain and Ireland, AAGBI WSM 2018. United
Kingdom. 73 (Supplement 2) (pp 64), 2018. Date of Publication: January
2018.
Publisher
Blackwell Publishing Ltd
Abstract
Methods Inadvertent peri-operative hypothermia (IPH) is a common but
preventable complication of operative procedures caused by the
redistribution of heat as a consequence of general and/or regional
anaesthesia. It is associated with poor outcomes such as cardiac
morbidity, surgical site infections, longer hospital admissions, increased
blood loss and rates of blood transfusions, all of which can have
significant cost implications. NICE guidance [1] recommends the use of
active warming in the peri-operative environment to prevent IPH. The
purpose of this study was to look at the health economics of
peri-operative warming by determining the costs of the consequences of IPH
(specifically costs associated with increased blood loss and rates of
transfusions) and comparing this to the cost of peri-operative warming to
prevent IPH. We quantified the increased risk of blood loss and
transfusion rates using data from a systematic review of randomised
controlled trials [2], which compared blood loss and transfusion rates
across different surgery types for normothermic and hypothermic patients.
We applied this to two pathways, one with and one without warming. We
applied the cost of a forced air warming system to the warming pathway and
established costs for blood acquisition, expected transfusion rates by
surgery type and IPH rates, then modelled the results. We presented a base
case and ran alternative scenarios to account for uncertainty. Results The
base case for warming all patients undergoing hip surgery (lower
transfusion rates and blood costs) was an additional 1.89 per patient.
Base case for cardiac surgery (higher transfusion rates and blood costs)
showed a net saving of -3.60 per patient. When running alternative
scenarios, the incremental cost was generally < 5 per patient for hip, and
net savings for cardiac were still achieved. The largest effect was when
an additional warming modality was introduced as this doubled the warming
cost (hip + 13.60 per patient and cardiac + 6.58 per patient) but may be
balanced by better outcomes. Discussion The model results support uptake
of peri-operative warming based on one consequence of IPH with either a
small incremental cost or net saving dependent on complexity of surgery.
There are several uncertainties such as the level of increased transfusion
risk in normothermic vs. hypothermic patients but even a small difference
will have both cost and clinical consequences. Greater cost effectiveness
can be achieved when other complications are accounted for.

<16>
Accession Number
620355552
Author
Abbas S.; Memon S.; Shaikh M.; Iqbal M.; Riaz W.; Hussain M.
Institution
(Abbas, Memon, Shaikh, Iqbal, Riaz, Hussain) Department of Sardiology,
Liaquat University Hospital, Hyderabad, Pakistan
Title
Marital status, an independent prognostic factor for Out of hospital
mortality after coronary artery bypass grafting (CABG).
Source
European Journal of Medical Research. Conference: 1st Liaquat University
of Medical and Health Sciences, LUMHS PAK International Medical Research
Conference. Pakistan. 22 (Supplement 1) (no pagination), 2016. Date of
Publication: 2016.
Publisher
BioMed Central Ltd.
Abstract
Marital status has been associated as an independent prognostic factor for
survival in variety of tumors, for its additional social support. The aim
of the study is to refect on whether marital status has any association
with mortality in patients at 1 year after post CABG hospital discharge.
Computer based randomized prospective case (married) control (unmarried)
study. Out patients Department of Punjab Institute of Cardiology, Lahore.
From January 2010 to December 2014, a computer based randomization
performed to select 100 patients in each of Group A (married) and Group B
(unmarried), with ages between 35 and 70 years. CABG related survival
(CRS) was compared between two groups 1 year after CABG. The mean age of
the patients was 50.63 +/- 15.33 years. Group A is found younger (48.36
+/- 16.43 vs 55.66 +/- 17.23) with decreased hospital stay (8.39 +/- 4.7
vs 16.0 +/- 5.84) and early recovery after CABG (98% vs 88%). CPB time and
mean cross clamp time was insignificant (p > 0.05). Ninety patients were
found to be asymptomatic 1 year after CABG in Group A, in contrast to 78
patients in Group B. The reported mortality was 2% in Group A whereas 12%
in Group B. There is significant relationship between 1 year survival and
marital status of patients who underwent CABG.

<17>
Accession Number
620299310
Author
Wang X.; Wang C.; Ye M.; Lin J.; Jin J.; Hu Q.; Zhu C.; Chen B.
Institution
(Wang, Wang, Ye, Lin, Jin, Hu, Zhu, Chen) Department of Thoracic and
Cardiovascular Surgery, Affiliated Taizhou Hospital, Wenzhou Medical
University, Taizhou, China
Title
Left atrial concomitant surgical ablation for treatment of atrial
fibrillation in cardiac surgery: A meta-analysis of randomized controlled
trials.
Source
PLoS ONE. 13 (1) (no pagination), 2018. Article Number: e0191354. Date of
Publication: January 2018.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Introduction Surgical ablation is a generally established treatment for
patients with atrial fibrillation undergoing concomitant cardiac surgery.
Left atrial (LA) lesion set for ablation is a simplified procedure
suggested to reduce the surgery time and morbidity after procedure. The
present meta-analysis aims to explore the outcomes of left atrial lesion
set versus no ablative treatment in patients with AF undergoing cardiac
surgery. Methods A literature research was performed in six database from
their inception to July 2017, identifying all relevant randomized
controlled trials (RCTs) comparing left atrial lesion set versus no
ablative treatment in AF patient undergoing cardiac surgery. Data were
extracted and analyzed according to predefined clinical endpoints. Results
Eleven relevant RCTs were included for analysis in the present study. The
prevalence of sinus rhythm in ablation group was significantly higher at
discharge, 6-month and 1-year follow-up period. The morbidity including 30
day mortality, late all-cause mortality, reoperation for bleeding,
permanent pacemaker implantation and neurological events were of no
significant difference between two groups. Conclusions The result of our
meta-analysis demonstrates that left atrial lesion set is an effective and
safe surgical ablation strategy for AF patients undergoing concomitant
cardiac surgery.<br/>Copyright &#xa9; 2018 Wang et al. This is an open
access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<18>
Accession Number
620367610
Author
Alassas K.; Mohty D.; Clavel M.A.; Husain A.; Hijji T.; Aljoufan M.;
Alhalees Z.; Fadel B.M.
Institution
(Alassas, Mohty, Husain, Hijji, Fadel) Sections of Adult Cardiology, King
Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
(Aljoufan) Pediatric Cardiology, King Faisal Specialist Hospital and
Research Center, Riyadh, Saudi Arabia
(Alhalees) Cardiac Surgery, Heart Center, King Faisal Specialist Hospital
and Research Center, Riyadh, Saudi Arabia
(Mohty) Department of Cardiology, Dupuytren University Hospital, Limoges,
France
(Clavel) Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
Title
Transcatheter versus surgical valve replacement for a failed pulmonary
homograft in the Ross population.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Patients who undergo the Ross procedure are at increased risk
of pulmonary valve (PV) homograft dysfunction. For those who require
reintervention on the homograft, transcatheter PV replacement (tPVR)
provides a less invasive therapeutic option than surgical PVR (sPVR). We
examined the outcomes following tPVR versus sPVR in a cohort of patients
who underwent the Ross procedure. Methods: We performed a retrospective
analysis of Ross patients age >=14 years who underwent tPVR (n = 47) or
sPVR (n = 41) at our institution. The patients' clinical and
echocardiographic data were reviewed. Results: Baseline parameters,
including demographic data and left ventricular and right ventricular (RV)
systolic function, were similar in the 2 groups. The mean follow-up was 56
+/- 24 months for the tPVR group and 89 +/- 46 months for the sPVR group
(P < .001). No procedure-related mortality was noted in either group. At
6-year follow-up, there was no significant between-group difference in
event-free survival (tPVR, 79% +/- 7% vs sPVR, 91% +/- 4%; P = .15) or PV
reintervention (tPVR, 26% +/- 9% vs sPVR, 8% +/- 5%; P = .31).
PV-associated infective endocarditis (IE) was significantly more common
with tPVR (tPVR, 13% vs sPVR, 0%; P = .04), with an annualized rate of
2.98% per patient-year. In addition, there was a trend toward more valve
dysfunction following sPVR (sPVR, 67% +/- 8% vs tPVR, 35% +/- 8%; P =
.08). Conclusions: In Ross patients who require reintervention on the PV
homograft, both tPVR and sPVR provide low procedural mortality and
comparable midterm outcome with no significant difference in mortality or
PV reintervention. However, IE is more common following tPVR. A larger
randomized study is needed to determine the role of each procedure in
patient management.<br/>Copyright &#xa9; 2017 The American Association for
Thoracic Surgery.

<19>
Accession Number
620365390
Author
Cavalcante C.T.D.M.B.; Pinto Junior V.C.; Pompeu R.G.; Ferrer J.V.C.C.;
Cavalcante M.B.; Araujo Junior E.; Peixoto A.B.; Castello Branco K.M.
Institution
(Cavalcante, Pinto Junior, Pompeu, Ferrer, Castello Branco) Department of
Cardiology and Pediatric Cardiovascular Surgery, Carlos Alberto Studart
Gomes Hospital, Fortaleza, Brazil
(Cavalcante) Department of Pediatrics, Fortaleza University (UNIFOR),
Fortaleza, Brazil
(Cavalcante) Department of Obstetrics and Gynecology, Fortaleza University
(UNIFOR), Fortaleza, Brazil
(Araujo Junior) Department of Obstetrics, Paulista School of Medicine,
Federal University of Sao Paulo (EPM-UNIFESP), Sao Paulo, Brazil
(Peixoto) Mario Palmerio University Hospital, University of Uberaba
(UNIUBE), Uberaba, Brazil
(Peixoto) Discipline of Obstetrics and Gynecology, Federal University of
Triangulo Mineiro (UFTM), Uberaba, Brazil
(Castello Branco) Post graduation Program in Organ Transplantation, State
University of Ceara (UECE), Fortaleza, Brazil
Title
Early treatment of intrapericardial teratoma: a case presentation and
systematic literature review.
Source
Journal of Maternal-Fetal and Neonatal Medicine. (pp 1-7), 2018. Date of
Publication: 23 Jan 2018.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Objective: To present a case of an early treatment of cardiac
intraperitoneal teratoma (IPT) in a newborn and its associated systematic
literature review. Methods: We presented a case of a newborn with IPT but
without hydrops and having a good perinatal outcome after cardiac surgery.
Using the PubMed database, we conducted a systematic literature review of
articles regarding cases with cardiac IPT diagnosed and treated in the
neonatal period and published in English from 2004 onward. We excluded
cases that involved fetal death or interrupted gestation events. Results:
In total, 38 cases of IPT from 31 articles were included. The
mean+/-standard deviation of the gestational age at diagnosis and delivery
were 27.9+/-5.7 and 33.0+/-3.5 weeks, respectively, and that of birth
weight was 2373+/-834.5g. The majority of fetuses (42.1%) were males.
Pericardial effusion was the most common symptom (60.5%) followed by
hydrops (42.1%) and respiratory distress (42.1%). Intrauterine procedure
was not performed in 63.1% of cases, and 71.0% of newborns were alive.
Conclusions: IPT in newborns is usually associated with a good prognosis
without the need for intrauterine procedures. Cases with IPT-related death
are associated with hemodynamic impairment in fetuses with
hydrops.<br/>Copyright &#xa9; 2018 Informa UK Limited, trading as Taylor &
Francis Group

<20>
Accession Number
618813138
Author
Wang Y.; Wen M.; Zhou J.; Chen Y.; Zhang Q.
Institution
(Wang, Wen, Zhou, Chen, Zhang) Department of Cardiology, West China
Hospital, Sichuan University, Chengdu, China
Title
Coronary artery bypass grafting versus percutaneous coronary intervention
in patients with noninsulin treated type 2 diabetes mellitus: A
meta-analysis of randomized controlled trials.
Source
Diabetes/Metabolism Research and Reviews. 34 (1) (no pagination), 2018.
Article Number: e2951. Date of Publication: January 2018.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: The outcomes and prognosis of revascularization by either
coronary artery bypass grafting (CABG) surgery or percutaneous coronary
intervention (PCI) in patients with noninsulin-treated type 2 diabetes
mellitus (NITDM) have not yet been well established. Methods: Randomized
controlled trials (RCTs) were identified by searching Pubmed, EMBASE, and
Cochrane library from inception until May 2016. Heterogeneity was
evaluated, and the pooled hazard ratio (HR) was calculated by using a
fixed-effect model. A random-effect model was used when statistically
significant heterogeneity was observed (I² >= 50%). All data
analyses were carried out by using RevMan 5.3 and STATA software 12.0.
Results: A total of 4 RCTs involving 5 studies, consisting of 2270
patients with noninsulin-treated type 2 diabetes mellitus, were
identified. Compared with CABG-treated patients, PCI-treated patients had
significantly higher all-cause mortality (HR 1.39; 95% CI 1.01 to 1.91; P
=.04), myocardial infarction (HR 2.14; 95% CI 1.40 to 3.27; P =.0004),
repeated revascularization (HR 2.52; 95% CI 1.77 to 3.57; P <.00001), and
major adverse cardiovascular and cerebrovascular events (HR 1.50; 95% CI
1.20-1.87; P =.0004). However, PCI was associated with lower incidence of
stoke (HR 0.47; 95% CI 0.24 to 0.90; P =.02). Conclusions: In NITDM
patients, our study suggests that CABG surgery is associated with reduced
risk of mortality and morbidity, although with increased incidence of
stroke compared with percutaneous coronary intervention. The decision if
to have percutaneous coronary intervention or CABG surgery should factor
the risk for stroke of the patients when considering CABG over
percutaneous coronary intervention. Adequately powered RCTs are needed to
confirm the results of this meta-analysis.<br/>Copyright &#xa9; 2017 John
Wiley & Sons, Ltd.

<21>
Accession Number
618198316
Author
Akintoye E.; Sellke F.; Marchioli R.; Tavazzi L.; Mozaffarian D.
Institution
(Akintoye) Department of Internal Medicine, Wayne State University School
of Medicine, Detroit, Mich, United States
(Sellke) Department of Cardiothoracic Surgery, Alpert Medical School,
Brown University, Providence, RI, United States
(Marchioli) Department of Hematology and Oncology, Therapeutic Science and
Strategy Unit, Quintiles, Milan, Italy
(Tavazzi) Department of Cardiology and LTTA Centre, University of Ferrara,
Ferrara, Italy; Maria Cecilia Hospital- GVM Care & Research, E.S. Health
Science Foundation, Cotignola, Italy
(Mozaffarian) Friedman School of Nutrition Science & Policy, Tufts
University, Boston, Mass, United States
Title
Factors associated with postoperative atrial fibrillation and other
adverse events after cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (1) (pp 242-251.e10),
2018. Date of Publication: January 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective The study objective was to evaluate the impact of various
surgical characteristics and practices on the risk of postoperative atrial
fibrillation and other adverse outcomes after cardiac surgery. Methods By
using the prospectively collected data of patients who underwent cardiac
surgery in 28 centers across the United States, Italy, and Argentina, the
details of surgery characteristics were collected for each patient and the
outcomes, including postoperative atrial fibrillation, major adverse
cardiovascular events, and mortality. These were evaluated via
multivariable-adjusted models. Results In 1462 patients, a total of 460
cases of postoperative atrial fibrillation, 33 major adverse
cardiovascular events, 23 cases of 30-day mortality, and 46 cases of
1-year mortality occurred. We found that type of surgery and
cardiopulmonary bypass use predicted the occurrence of postoperative
atrial fibrillation. Compared with coronary artery bypass grafting alone,
there was a higher risk of postoperative atrial fibrillation with valvular
surgery alone (odds ratio, 1.4; 95% confidence interval, 1.1-1.9), and the
risk was even higher with concomitant valvular and coronary artery bypass
grafting surgery (odds ratio, 1.8; 95% confidence interval, 1.2-2.7).
Compared with no bypass, use of cardiopulmonary bypass was associated with
higher risk of postoperative atrial fibrillation (odds ratio, 2.4; 95%
confidence interval, 1.7-3.5), but there were significant age and sex
differences of the impact of bypass use among patients undergoing coronary
artery bypass grafting (P for interaction =.04). In addition, compared
with spontaneous return of rhythm, ventricular pacing was associated with
a higher risk of major adverse cardiovascular events (odds ratio, 5.0; 95%
confidence interval, 1.4-18), whereas concomitant coronary artery bypass
grafting and valvular surgery was associated with a higher risk of 30-day
mortality (hazard ratio, 4.3; 95% confidence interval, 1.2-14) compared
with coronary artery bypass grafting alone. Occurrence of postoperative
atrial fibrillation was associated with greater length of stay and 1-year
mortality (hazard ratio, 2.2; 95% confidence interval, 1.2-3.9).
Conclusions In this multicenter trial, we identified specific adverse
outcomes that are associated with concomitant valvular and coronary artery
bypass graft surgery, cardiopulmonary bypass, ventricular pacing, and
occurrence of postoperative atrial fibrillation.<br/>Copyright &#xa9; 2017
The American Association for Thoracic Surgery

<22>
Accession Number
619776295
Author
Ram P.; Mezue K.; Pressman G.; Rangaswami J.
Institution
(Ram, Mezue, Rangaswami) Department of Internal Medicine, Einstein Medical
Center, Philadelphia, PA, United States
(Pressman) Heart and Vascular Institute, Division of Cardiology, Einstein
Medical Center, Philadelphia, PA, United States
Title
Acute kidney injury post-transcatheter aortic valve replacement.
Source
Clinical Cardiology. 40 (12) (pp 1357-1362), 2017. Date of Publication:
December 2017.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Transcatheter aortic valve replacement (TAVR) is a treatment option in
high-risk patients with severe aortic stenosis who are not surgical
candidates. In light of emerging evidence, it is being increasingly
performed even in intermediate-risk patients in recent years. Patients who
develop acute kidney injury (AKI) following TAVR are known to have worse
outcomes. The objective of this concise review was to identify the
prevalence and the impact of AKI following TAVR on patient outcomes by
including the most recent literature in our search. After a thorough
search on MEDLINE, Google Scholar, and PubMed, we included all literature
relevant to AKI following TAVR. We found that AKI was caused by a variety
of reasons, such as hemodynamic instability during rapid pacing, blood
transfusion, periprocedural embolization, and use of contrast medium, to
name a few. In patients who developed AKI following TAVR, 30-day and
1-year mortality were increased. Further, in these patients, length and
cost of hospital stay were increased as well. Preventive measures such as
optimal periprocedural hydration, careful contrast use, and techniques to
prevent embolization during device implantation have been tried with
limited success. Given that TAVR is expected to be increasingly performed,
this review aimed to summarize the rapidly expanding currently available
literature in an effort to reduce procedural complications and thereby
improve patient outcomes.<br/>Copyright &#xa9; 2017 Wiley Periodicals,
Inc.

<23>
Accession Number
619426992
Author
Clifton P.M.; Keogh J.B.
Institution
(Clifton, Keogh) School of Pharmacy and Medical Sciences, Alliance for
Research in Exercise, Nutrition and Activity, University of South
Australia, Sansom Institute for Health Science, University of South
Australia, GPO Box 2471, Adelaide, SA 5000, Australia
Title
A systematic review of the effect of dietary saturated and polyunsaturated
fat on heart disease.
Source
Nutrition, Metabolism and Cardiovascular Diseases. 27 (12) (pp 1060-1080),
2017. Date of Publication: December 2017.
Publisher
Elsevier B.V.
Abstract
Aims Over the last 7 years there has been intense debate about the advice
to reduce saturated fat and increase polyunsaturated fat to reduce CVD
risk. The aim of this review was to examine systematic reviews and
meta-analyses since 2010 on this topic plus additional cohort studies and
interventions not included in these reviews. Data Synthesis High saturated
and trans fat intake (which elevates LDL like saturated fat) in the Nurses
and Health Professional Follow-Up Studies combined is associated with an
8-13% higher mortality and replacement of saturated fat with any
carbohydrate, PUFA and MUFA is associated with lower mortality with PUFA
being more effective than MUFA (19% reduction versus 11%). With CVD
mortality only PUFA and fish oil replacement of saturated fat lowers risk
with a 28% reduction in CVD mortality per 5% of energy. Replacing
saturated fat with PUFA or MUFA is equally effective at reducing CHD
events and replacement with whole grains will lower events while
replacement with sugar and starch increases events. Replacement of
saturated fat with carbohydrate has no effect on CHD events or death. Only
PUFA replacement of saturated fat lowers CHD events and CVD and total
mortality. Replacing saturated fat with linoleic acid appears to be
beneficial based on the Hooper Cochrane meta-analysis of interventions
although other analyses with fewer studies have shown no effect.
Conclusions Reducing saturated fat and replacing it with carbohydrate will
not lower CHD events or CVD mortality although it will reduce total
mortality. Replacing saturated fat with PUFA, MUFA or high-quality
carbohydrate will lower CHD events.<br/>Copyright &#xa9; 2017 The Italian
Society of Diabetology, the Italian Society for the Study of
Atherosclerosis, the Italian Society of Human Nutrition, and the
Department of Clinical Medicine and Surgery, Federico II University

<24>
[Use Link to view the full text]
Accession Number
620308238
Author
Krishnamoorthy B.; Critchley W.R.; Nair J.; Malagon I.; Carey J.; Barnard
J.B.; Waterworth P.D.; Venkateswaran R.V.; Fildes J.E.; Caress A.L.; Yonan
N.
Institution
(Krishnamoorthy, Malagon, Carey, Barnard, Waterworth, Venkateswaran,
Yonan) Department of Cardiothoracic Surgery, University Hospital of South
Manchester NHS Foundation Trust, Manchester M23 9LT, United Kingdom
(Krishnamoorthy) Faculty of Health and Social Care, Edge Hill University,
Ormskirk, Lancashire, United Kingdom
(Critchley, Nair, Fildes) Manchester Collaborative Centre for Inflammation
Research, Faculty of Medical and Human Sciences, University of Manchester,
Manchester, United Kingdom
(Caress) School of Nursing and Midwifery, University of Manchester,
Manchester, United Kingdom
Title
Randomized Study Comparing the Effect of Carbon Dioxide Insufflation on
Veins Using 2 Types of Endoscopic and Open Vein Harvesting.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 12 (5) (pp 320-328), 2017. Date of Publication: 01 Sep 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective: The aim of the study was to assess whether the use of carbon
dioxide insufflation has any impact on integrity of long saphenous vein
comparing 2 types of endoscopic vein harvesting and traditional open vein
harvesting. Methods: A total of 301 patients were prospectively randomized
into 3 groups. Group 1 control arm of open vein harvesting (n = 101),
group 2 closed tunnel (carbon dioxide) endoscopic vein harvesting (n =
100) and Group 3 open tunnel (carbon dioxide) endoscopic vein harvesting
(open tunnel endoscopic vein harvesting) (n = 100). Each group was
assessed to determine the systemic level of partial arterial carbon
dioxide, end-tidal carbon dioxide, and pH. Three blood samples were
obtained at baseline, 10 minutes after start of endoscopic vein
harvesting, and 10 minutes after the vein was retrieved. Vein samples were
taken immediately after vein harvesting without further surgical handling
to measure the histological level of endothelial damage. A modified
validated endothelial scoring system was used to compare the extent of
endothelial stretching and detachment. Results: The level of end-tidal
carbon dioxide was maintained in the open tunnel endoscopic vein
harvesting and open vein harvesting groups but increased significantly in
the closed tunnel endoscopic vein harvesting group (P = 0.451, P = 0.385,
and P < 0.001). Interestingly, partial arterial carbon dioxide also did
not differ over time in the open tunnel endoscopic vein harvesting group
(P = 0.241), whereas partial arterial carbon dioxide reduced significantly
over time in the open vein harvesting group (P = 0.001). A profound
increase in partial arterial carbon dioxide was observed in the closed
tunnel endoscopic vein harvesting group (P < 0.001). Consistent with these
patterns, only the closed tunnel endoscopic vein harvesting group
demonstrated a sudden drop in pH over time (P < 0.001), whereas pH
remained stable for both open tunnel endoscopic vein harvesting and open
vein harvesting groups (P = 0.105 and P = 0.869, respectively).
Endothelial integrity was better preserved in the open vein harvesting
group compared with open tunnel endoscopic vein harvesting or closed
tunnel endoscopic vein harvesting groups (P = 0.012) and was not affected
by changes in carbon dioxide or low pH. Significantly greater stretching
of the endothelium was observed in the open tunnel endoscopic open tunnel
endoscopic vein harvesting group compared with the other groups (P =
0.003). Conclusions: This study demonstrated that the different vein
harvesting techniques impact on endothelial integrity; however, this does
not seem to be related to the increase in systemic absorption of carbon
dioxide or to the pressurized endoscopic tunnel. The open tunnel
endoscopic harvesting technique vein had more endothelial stretching
compared with the closed tunnel endoscopic technique; this may be due to
manual dissection of the vein. Further research is required to evaluate
the long-term clinical outcome of these vein grafts.<br/>&#xa9; Copyright
2017 by the International Society for Minimally Invasive Cardiothoracic
Surgery.

<25>
[Use Link to view the full text]
Accession Number
620308203
Author
Ferdinand F.D.; MacDonald J.K.; Balkhy H.H.; Bisleri G.; Hwang H.Y.;
Northrup P.; Trimlett R.H.J.; Wei L.; Kiaii B.B.
Institution
(Ferdinand, Northrup) Division of Cardiothoracic Surgery, Albany Medical
College, 563 New Scotland Ave, MC 8656, Albany, NY 12208, United States
(MacDonald) Department of Medicine, University of Western Ontario, London,
ON, Canada
(Balkhy) Section of Cardiac and Thoracic Surgery, University of Chicago
Medicine and Biological Sciences, Chicago, IL, United States
(Bisleri) Division of Cardiac Surgery, Kingston General Hospital,
Kingston, ON, Canada
(Hwang) Division of Cardiac Surgery, Seoul National University Hospital,
Seoul, South Korea
(Trimlett) Department of Surgery, Royal Brompton and Harefield NHS
Foundation Trust, London, United Kingdom
(Wei) Division of Cardiovascular Surgery, Zhongshan Hospital of Fudan
University, Shanghai, China
(Kiaii) Division of Cardiac Surgery, University Campus, Western
University, London, ON, Canada
Title
Endoscopic Conduit Harvest in Coronary Artery Bypass Grafting Surgery: An
ISMICS Systematic Review and Consensus Conference Statements.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 12 (5) (pp 301-319), 2017. Date of Publication: 01 Sep 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective: The purpose of this consensus conference was to develop and
update evidence-informed consensus statements and recommendations on
harvesting saphenous vein and radial artery via an open as compared with
endoscopic technique by systematically reviewing and performing a
meta-analysis of randomized and nonrandomized clinical trials. Methods:
All randomized controlled trials and nonrandomized controlled trials
included in the first the International Society for Minimally Invasive
Cardiothoracic Surgery Consensus Conference and Statements,^1,2
in 2005 up to November 30, 2015, were included in a systematic review and
meta-analysis. Based on the resultant, 76 studies (23 randomized
controlled trials and 53 nonrandomized controlled trials) on 281,459
patients analyzed, consensus statements, and recommendations were
generated comparing the risks and benefits of endoscopic versus open
conduit harvesting for patients undergoing coronary artery bypass
grafting. Results: Compared with open vein harvest, it is reasonable to
perform endoscopic vein harvest of saphenous vein to reduce wound-related
complications, postoperative length of stay, and outpatient wound
management resources and to increase patient satisfaction (class I, level
A). Based on the quality of the conduit and major adverse cardiac events
as well as 6-month angiographic patency, endoscopic vein harvest was
noninferior to open harvest. It is reasonable to perform endoscopic radial
artery harvest to reduce wound-related complication and to increase
patient satisfaction (class I, level B-R and B-NR, respectively) with
reduction in major adverse cardiac events and noninferior patency rate at
1 and 3 to 5 years (class III, level B-R). Conclusions: Based on the
consensus statements, the consensus panel recommends (class I, level B)
that endoscopic saphenous vein and radial artery harvesting should be the
standard of care for patients who require these conduits for coronary
revascularization.<br/>&#xa9; Copyright 2017 by the International Society
for Minimally Invasive Cardiothoracic Surgery.

<26>
Accession Number
615618126
Author
Vierhout B.P.; Pol R.A.; El Moumni M.; Zeebregts C.J.
Institution
(Vierhout) Department of Surgery, Wilhelmina Ziekenhuis Assen,
Europaweg-Zuid 1, Assen 9401 RK, Netherlands
(Pol, El Moumni) Department of Surgery, University Medical Centre
Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB,
Netherlands
(Zeebregts) Department of Surgery, Division of Vascular Surgery,
University Medical Centre Groningen, University of Groningen, Hanzeplein
1, Groningen 9700 RB, Netherlands
Title
Editor's Choice - Arteriotomy Closure Devices in EVAR, TEVAR, and TAVR: A
Systematic Review and Meta-analysis of Randomised Clinical Trials and
Cohort Studies.
Source
European Journal of Vascular and Endovascular Surgery. 54 (1) (pp
104-115), 2017. Date of Publication: July 2017.
Publisher
W.B. Saunders Ltd
Abstract
Objectives Cardiac and vascular surgery benefit from percutaneous
interventions. Arteriotomy closure devices (ACDs) enable minimally
invasive access to the common femoral artery (CFA). The objective of this
review was to assess the differences between ACDs and surgical cut down
(SCD) of the CFA regarding the number of complications, duration of
surgery (DOS), and hospital length of stay (HLOS). Design A systematic
literature search with predefined search terms was performed using
MEDLINE, Embase, and the Cochrane Library (2000-2016). All studies
reporting on ACD and SCD for a puncture of the CFA of at least 12 French
(Fr.) were assessed for eligibility. Methods Included were randomised
controlled trials and cohort studies comparing both techniques. Patient
characteristics, exclusion criteria, and conversion rates were evaluated.
Complications, DOS, and HLOS were compared. Materials A total of 17
studies were included for meta-analysis, describing 7889 vascular access
sites; four studies were randomised trials, two studies reported from a
prospective database, and 11 studies reported retrospective cohorts.
Results ACD was associated with fewer post-operative seromas (odds ratio
[OR] 0.15, 95% confidence interval [CI] 0.06-0.35), less wound dehiscence
(OR 0.14, 95% CI 0.03-0.78), and fewer surgical site infections (OR 0.38,
95% CI 0.23-0.63). Post-operative pseudoaneurysms were significantly more
common in the ACD group (OR 3.83, 95% CI 1.55-9.44). In five of 17
studies, DOS and HLOS were not reduced in the ACD group. When all studies
reporting a mean DOS and/or HLOS were compared in a non-parametric
analysis, neither was significantly different. Conclusion This
meta-analysis favours ACD regarding the number of wound complications
compared with SCD in endovascular aneurysm repair, thoracic endovascular
aneurysm repair, and transcatheter aortic valve repair. Treatment duration
(DOS and HLOS) was not reduced in ACD. The differences are of limited
clinical significance and with this equivocal quality of evidence, the ACD
may be considered safe for CFA access in suitable patients.<br/>Copyright
&#xa9; 2017 European Society for Vascular Surgery

<27>
Accession Number
614085660
Author
Friedberg M.K.; Schwartz S.M.; Zhang H.; Chiu-Man C.; Manlhiot C.; Ilina
M.V.; Arsdell G.V.; Kirsh J.A.; McCrindle B.W.; Stephenson E.A.
Institution
(Friedberg, Schwartz, Zhang, Chiu-Man, Manlhiot, Ilina, Arsdell, Kirsh,
McCrindle, Stephenson) Labatt Family Heart Center, The Hospital for Sick
Children, University of Toronto, Toronto, Ontario, Canada
Title
Hemodynamic effects of sustained postoperative cardiac resynchronization
therapy in infants after repair of congenital heart disease: Results of a
randomized clinical trial.
Source
Heart Rhythm. 14 (2) (pp 240-247), 2017. Date of Publication: 01 Feb 2017.
Publisher
Elsevier B.V.
Abstract
Background It is unknown whether continuous cardiac resynchronization
therapy (CRT) can lead to sustained improvement in hemodynamics after
surgery for congenital heart disease (CHD). Objective We investigated
whether CRT improves cardiac index (CI) and blood pressure in infants
after biventricular repair of CHD. Methods We randomized infants younger
than 4 months after biventricular CHD surgery to standard care or standard
care plus CRT for 48 hours or until extubation if sooner. Change in the
primary outcome of CI and blood pressure over time was compared between
groups. For subgroup analysis, QRS duration was considered prolonged if
greater than the 98th percentile. Results Forty-two patients were
randomized: 21 controls and 21 patients receiving CRT (median weight 4
kg). There were no identified adverse events from pacing. The change in CI
over time was not different between patients receiving CRT and controls,
but trended toward improvement in patients with wide QRS who received CRT
(n = 9) vs controls with wide QRS (n = 8) (+1.65 (0.86)
L/(min.m²); P = .06). Controls with wide QRS experienced the
smallest increase in CI (0.33 L/(min.m²)). Blood pressure was
significantly higher in infants with wide QRS who received CRT than in
controls (+7.14 (3.08) mm Hg; P = .02). Serum lactate level, catecholamine
use, ventilation time, and length of intensive care unit stay were similar
between the 2 groups. Conclusion CRT improved blood pressure and a trend
toward higher CI in infants after repair of biventricular CHD with
prolonged QRS duration. These findings warrant further study of CRT to
improve postoperative recovery in infants with electrical
dyssynchrony.<br/>Copyright &#xa9; 2016 Heart Rhythm Society

<28>
Accession Number
611451917
Author
Herrington W.G.; Emberson J.; Mihaylova B.; Blackwell L.; Reith C.; Solbu
M.D.; Mark P.B.; Fellstrom B.; Jardine A.G.; Wanner C.; Holdaas H.;
Fulcher J.; Haynes R.; Landray M.J.; Keech A.; Simes J.; Collins R.;
Baigent C.
Title
Impact of renal function on the effects of LDL cholesterol lowering with
statin-based regimens: a meta-analysis of individual participant data from
28 randomised trials.
Source
The Lancet Diabetes and Endocrinology. 4 (10) (pp 829-839), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Statin therapy is effective for the prevention of coronary
heart disease and stroke in patients with mild-to-moderate chronic kidney
disease, but its effects in individuals with more advanced disease,
particularly those undergoing dialysis, are uncertain. Methods We did a
meta-analysis of individual participant data from 28 trials (n=183 419),
examining effects of statin-based therapy on major vascular events (major
coronary event [non-fatal myocardial infarction or coronary death],
stroke, or coronary revascularisation) and cause-specific mortality.
Participants were subdivided into categories of estimated glomerular
filtration rate (eGFR) at baseline. Treatment effects were estimated with
rate ratio (RR) per mmol/L reduction in LDL cholesterol. Findings Overall,
statin-based therapy reduced the risk of a first major vascular event by
21% (RR 0.79, 95% CI 0.77-0.81; p<0.0001) per mmol/L reduction in LDL
cholesterol. Smaller relative effects on major vascular events were
observed as eGFR declined (p=0.008 for trend; RR 0.78, 99% CI 0.75-0.82
for eGFR >=60 mL/min per 1.73 m²; 0.76, 0.70-0.81 for eGFR 45
to <60 mL/min per 1.73 m²; 0.85, 0.75-0.96 for eGFR 30 to <45
mL/min per 1.73 m²; 0.85, 0.71-1.02 for eGFR <30 mL/min per
1.73 m²and not on dialysis; and 0.94, 0.79-1.11 for patients on
dialysis). Analogous trends by baseline renal function were seen for major
coronary events (p=0.01 for trend) and vascular mortality (p=0.03 for
trend), but there was no significant trend for coronary revascularisation
(p=0.90). Reducing LDL cholesterol with statin-based therapy had no effect
on non-vascular mortality, irrespective of eGFR. Interpretation Even after
allowing for the smaller reductions in LDL cholesterol achieved by
patients with more advanced chronic kidney disease, and for differences in
outcome definitions between dialysis trials, the relative reductions in
major vascular events observed with statin-based treatment became smaller
as eGFR declined, with little evidence of benefit in patients on dialysis.
In patients with chronic kidney disease, statin-based regimens should be
chosen to maximise the absolute reduction in LDL cholesterol to achieve
the largest treatment benefits. Funding UK Medical Research Council,
British Heart Foundation, Cancer Research UK, European Community Biomed
Programme, Australian National Health and Medical Research Council,
Australian National Heart Foundation.<br/>Copyright &#xa9; 2016 The
Author(s). Published by Elsevier Ltd. This is an Open Access article under
the CC BY license

<29>
Accession Number
611570467
Author
Lund M.; Tsai J.A.; Nilsson M.; Winter R.; Lundell L.; Kalman S.
Institution
(Lund, Kalman) Department of Anaesthesiology and Intensive Care,
Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm
141 86, Sweden
(Tsai, Nilsson, Lundell) Centre for Digestive Diseases, Karolinska
Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
(Winter) Department of Medicine, School of Technology and Health,
Karolinska University Hospital, Huddinge, Stockholm, Sweden
Title
Effects of neoadjuvant chemo or chemoradiotherapy for oesophageal cancer
on perioperative haemodynamics.
Source
European Journal of Anaesthesiology. 33 (9) (pp 653-661), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND Neoadjuvant chemoradiotherapy might improve oncological outcome
compared with chemotherapy after surgery for oesophagus or
gastrooesophageal junction cancer. However, radiotherapy may induce
cardiovascular side-effects that could increase the risk of perioperative
adverse effects and postoperative morbidity. OBJECTIVES The aim of this
study was to compare the perioperative haemodynamics in patients
undergoing oesophagectomy following neoadjuvant chemotherapy or
chemoradiotherapy for cancer. DESIGN A prospective single-centre cohort
study within a randomised multi-centre trial. SETTING A Swedish University
Hospital from January 2009 to March 2013. PATIENTS A total of 31 patients
(chemotherapy 17, chemoradiotherapy 14) included in a multi-centre trial
randomising chemotherapy vs. chemoradiotherapy and operated at Karolinska
University Hospital, Huddinge. INTERVENTIONS Cisplatin and 5-fluorouracil,
either with or without concurrent radiotherapy (40Gy), were given prior to
surgery. Cardiac function was assessed with LiDCOplus (LiDCO Ltd, London,
United Kingdom), echocardiography, troponin T and N-terminal pro-B-type
natriuretic peptide, before, during and after surgery. MAIN OUTCOME
MEASURES The primary outcome was the interaction effect of the neoadjuvant
treatment on stroke volume index during the perioperative period.
Secondary outcomes were the interaction effects of oxygen delivery index,
cardiac index, echocardiography and biochemical markers. RESULTS The
groups were matched regarding comorbidities, but patients in the
chemoradiotherapy group were older (66 vs. 60 years P=0.03). Haemodynamic
values changed in a similar way in both groups during the study period.
The chemoradiotherapy group had a lower cardiac index before surgery (2.9
vs. 3.4lmin^-1 m^-2, P=0.03). On the third
postoperative day, both groups displayed a hyperdynamic state compared
with baseline, with no increase in troponin T, and a similar increase in
N-terminal pro-B-type natriuretic peptide. CONCLUSION Neoadjuvant
chemoradiotherapy for oesophageal or gastrooesophageal junction cancer
seems to induce only a marginal negative effect on cardiac function
compared with neoadjuvant chemotherapy. This difference did not remain
when patients' haemodynamics were challenged by surgery.<br/>Copyright
&#xa9; 2016 European Society of Anaesthesiology.

<30>
Accession Number
611570460
Author
Eberl S.; Preckel B.; Bergman J.J.; Van Dieren S.; Hollmann M.W.
Institution
(Eberl, Preckel, Hollmann) Department of Anaesthesiology, Academic Medical
Centre, University of Amsterdam, Meibergdreef 9, Amsterdam 1100 DD,
Netherlands
(Bergman) Department of Gastroenterology and Hepatology, Academic Medical
Centre, University of Amsterdam, Amsterdam, Netherlands
(Van Dieren) Clinical Research Unit, Academic Medical Centre, University
of Amsterdam, Amsterdam, Netherlands
Title
Satisfaction and safety using dexmedetomidine or propofol sedation during
endoscopic oesophageal procedures.
Source
European Journal of Anaesthesiology. 33 (9) (pp 631-637), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND Dexmedetomidine possesses anxiolytic and hypnotic properties
without respiratory side-effects, making it theoretically an ideal
sedative agent for endoscopic procedures. OBJECTIVE We aimed to compare
satisfaction and safety among outpatients receiving sedation with
dexmedetomidine or propofol for endoscopic oesophageal procedures. DESIGN
A randomised controlled study. SETTING Endoscopic intervention suite at
the Academic Medical Centre in Amsterdam, Netherlands. PARTICIPANTS
Patients aged at least 18 years, and American Society of
Anesthesiologists' physical status 1 to 3. INTERVENTION Total 63 patients
were randomised to receive either dexmedetomidine (D) or propofol (P).
Pain was treated with alfentanil in both groups. MAIN OUTCOME MEASURES The
primary outcomes were patients' and endoscopists' satisfaction levels
measured by validated questionnaires (1=very dissatisfied; 7=highly
satisfied). A secondary outcome was safety, determined by blood pressure,
heart rate and oxygen saturation during and after the procedure, and
respiratory rate and noninvasive cardiac output during the procedure.
RESULTS Satisfaction of patients [median (IQR); group D, 5.0 (3.75 to
5.75) vs. group P, 6.25 (5.3 to 6.5)] and satisfaction of
gastroenterologists [group D, 5.0 (4.4 to 5.8) vs. group P, 6.0 (5.4 to
6.0)] were lower in group D (both P<0.001). More patients in group D would
not recommend this form of sedation to one of their friends (group D, 15
of 32 vs. group P, 1 of 31; P<0.001). Total 30min after the procedure,
heart rate [group D, 60bpm (52 to 69) vs. group P, 70bpm (60 to 81),
P=0.031] and SBP group D, 112mmHg (92 to 132) vs. group P, 120mmHg (108 to
132); P=0.013] were significantly lower after dexmedetomidine sedation.
There were no other differences in safety between groups. CONCLUSION
Compared with propofol, sedation with dexmedetomidine resulted in less
satisfaction, and caused prolonged haemodynamic depression after
endoscopic oesophageal procedures.<br/>Copyright &#xa9; 2016 European
Society of Anaesthesiology.

<31>
Accession Number
613012228
Author
Prescott E.; Meindersma E.P.; Van Der Velde A.E.; Gonzalez-Juanatey J.R.;
Iliou M.C.; Ardissino D.; Zoccai G.B.; Zeymer U.; Prins L.F.; Vant Hof
A.W.J.; Wilhelm M.; De Kluiver E.P.
Institution
(Prescott) Department of Cardiology, University of Copenhagen, Denmark
(Meindersma, Van Der Velde, Vant Hof, De Kluiver) Isala Heart Centre,
Dokter van Heesweg 2, Zwolle 8025AB, Netherlands
(Meindersma) Department of Cardiology, Radboud University, Netherlands
(Gonzalez-Juanatey) Department of Cardiology, University Hospital,
Santiago-de-Compostella, Spain
(Iliou) Department of Cardiac Rehabilitation, Assistance Publique Hopitaux
de Paris, France
(Ardissino) Department of Cardiology, Parma University Hospital, Italy
(Zoccai) Department of Medico-Surgical Sciences and Biotechnologies,
Sapienza University of Rome, Latina, Italy
(Zeymer) Klinikum Ludwigshafen, Institut fur Herzinfarktforschung
Ludwigshafen, Ludwigshafen, Germany
(Prins) Diagram B.V., Netherlands
(Wilhelm) Department of Cardiology, Universitat Bern, Switzerland
(Zoccai) Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli,
Italy
Title
A EUropean study on effectiveness and sustainability of current Cardiac
Rehabilitation programmes in the Elderly: Design of the EU-CaRE randomised
controlled trial.
Source
European Journal of Preventive Cardiology. 23 (2_suppl) (pp 27-40), 2016.
Date of Publication: 01 Oct 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background Cardiac rehabilitation (CR) is an evidence-based intervention
to increase survival and quality of life. Yet studies consistently show
that elderly patients are less frequently referred to CR, show less uptake
and more often drop out of CR programmes. Design The European study on
effectiveness and sustainability of current cardiac rehabilitation
programmes in the elderly (EU-CaRE) project consists of an observational
study and an open prospective, investigator-initiated multicentre
randomised controlled trial (RCT) involving mobile telemonitoring guided
CR (mCR). Objective The aim of EU-CaRE is to map the efficiency of current
CR of the elderly in Europe, and to investigate whether mCR is an
effective alternative in terms of efficacy, adherence and sustainability.
Methods and results The EU-CaRE study includes patients aged 65 years or
older with ischaemic heart disease or who have undergone heart valve
surgery. A total of 1760 patients participating in existing CR programmes
in eight regions of Europe will be included. Of patients declining regular
CR, 238 will be included in the RCT and randomised in two study arms. The
experimental group (mCR) will receive a personalised home-based programme
while the control group will receive no advice or coaching throughout the
study period. Outcomes will be assessed after the end of CR and at 12
months follow-up. The primary outcome is VO<inf>2peak</inf> and secondary
outcomes include variables describing CR uptake, adherence, efficacy and
sustainability. Conclusion The study will provide important information to
improve CR in the elderly. The EU-CaRE RCT is the first European
multicentre study of mCR as an alternative for elderly patients not
attending usual CR.<br/>Copyright &#xa9; European Society of Cardiology.

<32>
[Use Link to view the full text]
Accession Number
613955096
Author
Pedersen P.U.; Larsen P.; Hakonsen S.J.
Institution
(Pedersen, Larsen, Hakonsen) Danish Center of Systematic Reviews in
Nursing: a Collaborating Center of the Joanna Briggs Institute, Australia
Title
The effectiveness of systematic perioperative oral hygiene in reduction of
postoperative respiratory tract infections after elective thoracic surgery
in adults: A systematic review.
Source
JBI Database of Systematic Reviews and Implementation Reports. 14 (1) (pp
140-173), 2016. Date of Publication: 2016.
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
Nosocomial infections are a significant contributor to patient morbidity
and mortality. Nosocomial infections significantly increase hospital
length of stay and total hospital costs. Thoracic surgery, mechanical
ventilation and/or admission to an intensive care unit are known to
increase patients' risk for nosocomial respiratory tract infection.
Objectives To identify, appraise and synthesize the best available
evidence on the effectiveness of systematic perioperative oral hygiene in
the reduction of postoperative respiratory airway infections in adult
patients undergoing elective thoracic surgery. Inclusion criteria Types of
participants Patients over the age of 18 years who had been admitted for
elective thoracic surgery, regardless of gender, ethnicity, diagnosis
severity, co-morbidity or previous treatment. Types of intervention(s)
Perioperative systematic oral hygiene (such as mechanical removal of
dental biofilm or plaques and/or systematic use of mouth rinse) performed
by patients themselves or by healthcare staff (such as nurses). Types of
studies Randomized controlled trials and quasi-experimental studies. Types
of outcomes Nosocomial infections, specifically respiratory tracts
infections, and surgical site infections Search strategy Multiple
databases (PubMed, CINAHL, Embase, Scopus, Swemed+, Health Technology
Assessment Database and Turning Research Into Practice [TRIP] database)
were searched from 1980 to December 2014. Studies published in English,
German, Danish, Swedish and Norwegian were considered for inclusion in
this review. Methodological quality Two independent reviewers used the
standard critical appraisal tool from the Joanna Briggs Institute to
assess the methodological quality of studies. Data extraction The process
of data extraction was undertaken independently by two reviewers using
tools from the Joanna Briggs Institute. Data synthesis Quantitative
results were synthesized in meta-analysis. Results This review includes
six studies: three randomized controlled trials and three
quasi-experimental studies. The absolute magnitude of the summary effect
sizes were: for nosocomial infections relative risk (RR) 0.65 (95%
confidence interval [CI] 0.55-0.78) for respiratory tract infections RR
0.48 (95%CI: 0.36-0.65) and for deep surgical site infections RR 0.48
(95%CI 0.27-0.84). Conclusions Systematic perioperative oral hygiene
reduces postoperative nosocomial, lower respiratory tract infections and
surgical site infections but not urinary tract infections. The effect is
statistically, clinically and practically significant. Implications for
practice Perioperative decontamination of the nasopharynx and/or
oropharynx is a strategy worth pursuing. The intervention is cheap and can
easily be carried out by the patients themselves. (Grade A) Implications
for research Studies testing decontamination of the nasopharynx and/or
oropharynx have until now only included patients undergoing thoracic
surgical procedures. As the interventions are cheap, easy to carry out and
have a great impact on the patients' outcome, it is recommendable to carry
out more studies involving other type of patients undergoing major surgery
with a high prevalence of nosocomial infections, respiratory tract
infections and surgical site infections.<br/>Copyright &#xa9; the authors
2016.

<33>
Accession Number
610322093
Author
Yalonetsky S.; Aronson D.
Institution
(Yalonetsky, Aronson) Department of Cardiology, Rambam Healthcare Campus,
Ha-Alia Street, POB 9602, Haifa IL-31096, Israel
(Yalonetsky, Aronson) Ruth and Bruce Rappaport Faculty of Medicine,
Technion, Israel Institute of Technology, Haifa, Israel
Title
Biventricular Rupture with Extracardiac Left-to-Right Shunt Complicating
Acute Myocardial Infarction.
Source
Cardiology (Switzerland). 134 (4) (pp 389-393), 2016. Date of Publication:
27 Apr 2016.
Publisher
S. Karger AG
Abstract
Background: Simultaneous rupture of the left and right ventricles is an
extremely rare mechanical complication of acute myocardial infarction
(MI). When associated with the formation of a false aneurysm, an
extracardiac left-to-right shunt may occur. Methods: We summarized all
published data describing this unique condition. We searched the PubMed
and Google Scholar databases for case reports in peer-reviewed journals
from 1 January 1980 to 1 May 2015. We identified 16 articles describing 17
cases. Results: In all but 1 case, biventricular wall rupture (BVWR)
resulted from an inferior MI. The clinical presentations of BVWR were
variable and included cardiogenic shock, congestive heart failure and an
absence of any cardiac symptoms. In most cases, there was a
hemodynamically significant left-to-right shunt, with pulmonary to
systemic blood flow (Qp/Qs) >2. Diagnostic difficulties were reported in
most cases, and some patients were initially misdiagnosed as having
ventricular septal rupture (VSR). Surgical closure of the defect was
successful in most cases, and some asymptomatic patients were managed
conservatively. Conclusion: BVWR with an intact interventricular septum
and extracardiac left-to-right shunt is a rare mechanical complication of
acute MI, often misdiagnosed as VSR. It has a variable clinical course,
probably related to the magnitude of the shunt.<br/>Copyright &#xa9; 2016
S. Karger AG, Basel.

<34>
Accession Number
620335981
Author
Liontos L.; Fralick M.; Longmore A.; Hicks L.K.; Sholzberg M.
Institution
(Liontos) Department of Laboratory Medicine and Pathobiology, University
of Toronto, Toronto, Canada
(Fralick) Brigham and Women's Hospital, Harvard Medical School, Boston,
MA, United States
(Fralick) Clinician Scientist Training Program, University of Toronto,
Toronto, Canada
(Longmore) Hematology/Oncology, St. Michael's Hospital, Toronto, Canada
(Hicks) St. Michael's Hospital, Toronto, Canada
(Sholzberg) Hematology/Oncology Clinical Research Group, St. Michael's
Hospital, Toronto, Canada
(Sholzberg) Division of Hematology, St. Michael's Hospital, University of
Toronto, Toronto, Canada
(Sholzberg) St. Michael's Hospital, University of Toronto, Toronto, Canada
Title
Bleeding risk using INR/APTT pre-surgery: Systemtic review (bruisr)
(bruisr).
Source
Blood. Conference: 59th Annual Meeting of the American Society of
Hematology, ASH 2017. United States. 130 (Supplement 1) (no pagination),
2017. Date of Publication: December 2017.
Publisher
American Society of Hematology
Abstract
Background: Multiple published studies have shown that abnormal
coagulation tests, the prothrombin time (PT) and activated partial
thromboplastin time (aPTT), are not helpful in predicting peri-operative
bleeding. Despite numerous guidelines suggesting against their use, these
tests continue to be ordered routinely in many pre-operative or
pre-interventional settings. Objective: Our objective was to
systematically assess the utility of unselected pre-operative PT and aPTT
testing to predict bleeding outcomes. Data sources: We conducted a
systematic literature review of MEDLINE, EMBASE and Evidence-based
Medicine databases for articles published between 1970 and 2016 that
addressed pre-operative and/or pre-interventional coagulation testing that
was conducted in unselected fashion (i.e. not directed by the patient's
personal/family history). Two independent reviewers (LL and AL) screened
3373 articles and 207 studies were included for full-text review. Study
eligibility criteria: The minimum criteria for the 54 articles included in
our qualitative analysis were: adult and/or pediatric patients undergoing
elective surgery and/or an interventional procedure with pre-operative
coagulation test results (PT and/or international normalized ratio (INR)
and/or aPTT). Outcomes: The primary outcome was to examine the
relationship between pre-operative coagulation results and peri-operative
bleeding. As a secondary outcome, we also included studies that reported
on the frequency of abnormal tests in routinely screened pre-operative
patients as well as studies that described the cost of testing. Results:
Of the 54 articles we included in our systematic review, studies were
grouped according to procedure type: cardiac surgery (N=13), liver
transplant (N=7) and tonsillectomy (N=13), major surgery (as defined in
Choosing Wisely Canada, 2016) (N=12), and minor surgery (N=9). Within the
combined studies of tonsillectomy and minor surgery categories, a total of
21 studies (after exclusion of 4 for insufficient data), there was only 1
study that showed an association between abnormal pre-operative
coagulation testing and bleeding outcomes. Of the other 20 studies, 11
studies found no association between pre-operative coagulation studies and
bleeding events, 4 studies had no bleeding events identified, 4 showed
poor sensitivity of testing and 1 had no statistical information provided.
In the major surgery category, there were a total of 26 studies (which
included studies on liver transplant and cardiac surgery patients); only 4
studies identified an association between pre-operative coagulation
testing and bleeding events, 17 found no association, and 4 described poor
sensitivity of testing. In the studies that showed an association between
pre-operative coagulation testing and bleeding, many used subjective
definitions of bleeding, clinically insignificant thresholds to define
abnormal aPTT and/or INR or provided insufficient data to support their
conclusion. In summary, of the 45 studies with data on bleeding outcomes,
the majority (71%) showed no association between bleeding events and
pre-operative coagulation testing (Figure 1). As for assessment of
quality, there were no randomized controlled trials (RCT) identified and
the majority of observational studies were deemed at high risk of bias
Conclusion: To our knowledge, this is the largest systematic review that
assesses the utility of pre-operative coagulation screening as a predictor
of perioperative bleeding. Of the 54 studies that met our eligibility
criteria, only 5 showed an association between coagulation test results
and perioperative bleeding. Our findings support current guidelines which
caution against unselected pre-operative coagulation testing and also
emphasize the need for a welldesigned and powered prospective cohort study
or RCT to definitively answer this important question. (Figure Presented).

<35>
Accession Number
620335139
Author
Gagelmann N.; Ayuk F.A.; Wolschke C.; Kroeger N.
Institution
(Gagelmann, Ayuk, Wolschke, Kroeger) Department of Stem Cell
Transplantation, University Medical Center Hamburg- Eppendorf, Hamburg,
Germany
Title
Comparison of different rabbit anti-thymocyte globulin formulations in
allogeneic stem cell transplantation: Systematic literature review and
network meta-analysis.
Source
Blood. Conference: 59th Annual Meeting of the American Society of
Hematology, ASH 2017. United States. 130 (Supplement 1) (no pagination),
2017. Date of Publication: December 2017.
Publisher
American Society of Hematology
Abstract
Introduction Since 2000, phase III randomized controlled trials (RCT)
investigated the efficacy of rabbit anti-thymocyte globulins (ATG) in
patients following allogeneic stem cell transplantation (allo-SCT).
However, comparisons of different ATG formulations do not exist. Our aim
was to synthesize all efficacy evidence, enabling a comparison of all
available formulations of rabbit ATG in the allo-SCT setting. Methods We
performed a systematic literature review to identify all available phase
III RCTs using EMBASE , MEDLINE , MEDLINE in-process, the Cochrane Library
and the website www.clinical-trials.gov. In addition, meeting abstracts
(ASH, ASCO, EHA) were screened to include the most up-to-date evidence.
Studies were included if they described a phase III RCT among adult
patients who received rabbit globulins in the allo-SCT setting and if they
reported results of the following end points of interest: chronic
graft-versus-host-disease (GVHD, all grades), acute GVHD II-IV and III+IV,
transplant-related mortality (TRM), overall survival (OS), incidence of
relapse and CMV reactivation. The actual network meta-analysis (NMA) was
performed by using a conventional Bayesian fixed-effect framework and
hazard ratios (HR) for most end points while risk ratios (RR) were used
for dichotomous outcomes. Analyses were done with the R package netmeta.
The most common treatment, cyclosporine and methotrexate, was used as
reference treatment. Results We identified six phase III RCTs comprising
five full publications and one conference abstract between 2001 and 2016,
which investigated the following treatment options: 1) Grafalon (Neovii
Biotech, Graefelfing, Germany) consisting of polyclonal IgG obtained from
hyperimmune sera of rabbits immunized with the human Jurkat leukemic
T-cell line (ATLG), and 2) Thymoglobulin (Genzyme-Sanofi, Lyon, France),
in which immunization was done with human thymocytes recovered from
patients undergoing cardiac surgery (Thymo). The overall population
comprised 871 patients (ATLG: n = 610, and Thymo: n = 261). Population per
trial ranged from 27 to 126 patients in the ATG arm and from 25 to 128
patients in the non-ATG arm. The median age of patients ranged from 28 to
49 years. More patients were male, except in the ATG arm of one ATLG
trial. To include all trials within one framework, we had to assume: 1)
the relative efficacy of ATG versus cyclosporine and methotrexate was
identical to that of tacrolimus and methotrexate, which was used as
reference treatment in one ATLG trial; 2) no difference in efficacy due to
different graft sources or conditioning regimens; 3) no difference in
efficacy due to dosage scheme. Figure 1a-f presents the NMA results of the
main end points with HRs/RRs and 95% confidence intervals (CI) versus
standard treatment (cyclosporine and methotrexate). Only ATLG was
significantly better than standard treatment in preventing GVHD with a HR
of 0.42 (95% CI, 0.31 to 0.56) regarding chronic GVHD, and HRs of 0.54
(95% CI, 0.39 to 0.73) and 0.50 (95% CI, 0.29 to 0.86) regarding acute
GVHD II-IV and III+IV. The risk of chronic, acute GVHD II-IV and III+IV
was reduced by ATLG with 58%, 46% and 50% versus standard treatment. Both
ATLG and Thymo were at least similarly effective versus standard treatment
and showed no difference in relative efficacy regarding TRM with HRs of
0.90 (95% CI, 0.61 to 1.32) and 0.90 (95% CI, 0.56 to 1.44). Considering
OS, incidence of relapse and CMV reactivation, the NMA yielded at least
similar results of both formulations versus standard treatment, with Thymo
tending to be better regarding OS with a HR of 0.86 (95% CI, 0.59 to 1.26)
while resulting less clearly in better relative efficacy regarding relapse
with a HR of 0.92 (95% CI, 0.68 to 1.24) and CMV reactivation with a RR of
0.99 (95% CI, 0.84 to 1.16). Conclusions Our NMA compared all available
rabbit ATG formulations and identified ATLG being the best option to
prevent chronic and acute GVHD. Both formulations show similar efficacy in
TRM while Thymo tends to be better regarding OS. Since randomized
head-to-head comparisons are missing, this NMA provides a complete
overview of each formulation's relative efficacy. (Figure Presented).

<36>
Accession Number
620310306
Author
Kim S.K.; Papalekas E.; Friedman P.; Hage N.; Zhao J.; Ogunyemi D.
Institution
(Kim, Papalekas, Friedman, Hage, Ogunyemi) Beaumont Royal Oak, Royal Oak,
MI, United States
(Zhao) Oakland University, William Beaumont School of Medicine, Royal Oak,
MI, United States
Title
A system-based multidisciplinary severe maternal morbidity (SMM) committee
review from a single facility.
Source
American Journal of Obstetrics and Gynecology. Conference: 38th Annual
Meeting of the Society for Maternal-Fetal Medicine: The Pregnancy Meeting.
United States. 218 (1 Supplement 1) (pp S539), 2018. Date of Publication:
January 2018.
Publisher
Mosby Inc.
Abstract
OBJECTIVE: To describe the outcomes and contributing factors of a SMM
multidisciplinary review program STUDY DESIGN: The Joint Commission
recommends that SMM cases (peri-partum ICU admissions and transfusion of
>4 units of blood) undergo systemic reviews to determine opportunities for
improvement in care. The obstetrical unit developed a quarterly
multidisciplinary review of SMM cases with data extracted by members
employing a published template. RESULTS: From January 2015 to June 2017,
45 cases were reviewed. Transfusion of >4 units occurred in 55% and 69%
had ICU admission. Characteristics, etiologies and procedures are in
Table. Only 7% were sentinel events. All transports were due to
hypertensive crisis (100% vs. 33%, p=0.003) and all cardiac procedures
occurred in advanced maternal age (20% vs. 0%, p=0.033). Provider and
system factors determined by systemic review to contribute to SMM included
concerns with diagnosis 56%, treatment 44%, documentation 27%, education
24%, entry to healthcare 20%, referral to higher center 13%, team
communication 13%, equipment 7%, discharge 7%, policies and procedures 4%.
Analysis demonstrated that concerns with diagnosis could have altered
outcome by early recognition (52% vs. 10%, p=0.003). Patient factors
determined to contribute to SMM included psychiatric/behavioral health
20%, significant stressors 18% and healthcare barriers 22%. Patients with
healthcare barriers were more likely to have Medicaid insurance (p=0.03).
Those with significant stressors had more preterm births (100% vs. 51%,
p=0.01), and preexisting medical disease (75% vs. 30%, p=0.024). Patients
with psychiatric/behavioral health concerns also had more preterm births
(100% vs. 50%, p=0.005) and preexisting medical disease (78% vs. 29%,
p=0.009). CONCLUSION: Majority of SMM cases are not sentinel events; most
occur after preterm deliveries with approximately half due to medical
disease especially cardiac disease. Provider, system, and patient
contributors to SMM can be identified by multidisciplinary reviews. (Table
Presented).

<37>
Accession Number
620309647
Author
Cohen S.; Liu A.; Gurvitz M.; Guo L.; Therrien J.; Laprise C.; Kaufman J.;
Abrahamowicz M.; Marelli A.
Institution
(Cohen, Liu, Guo, Therrien, Marelli) McGill Adult Unit for Congenital
Heart Disease Excellence, Montreal, Canada
(Gurvitz) Children's Hospital Boston, Harvard Medical School, Boston,
United States
(Laprise) Division of Cancer Epidemiology, Canada
(Kaufman, Abrahamowicz) Department of Epidemiology, Biostatistics, and
Occupational Health, McGill University, Montreal, Canada
Title
Exposure to low-dose ionizing radiation from cardiac procedures and risk
of cancer in adults with congenital heart disease.
Source
Archives of Cardiovascular Diseases Supplements. Conference: 28es Journees
Europeennes de la Societe Francaise de Cardiologie, JESFC 2018. France. 10
(1) (pp 133-134), 2018. Date of Publication: January 2018.
Publisher
Elsevier Masson SAS
Abstract
Background The increasing exposure to low-dose ionizing radiation (LDIR)
from cardiac imaging in adults with congenital heart disease (ACHD) has
raised concerns about the risk of malignancy. Aim To estimate the
association between LDIR exposure from cardiac procedures and incident
cancer in ACHD. Methods This retrospective study of 24,833 ACHD aged 18-64
years from 1995-2009 was based on the Quebec CHD Database. Cumulative
numbers and cumulative effective dose of LDIR-related cardiac procedures
were measured for each patient. We assessed if high LDIR-exposure (>=6
procedures) was associated with an increased risk of cancer than low
LDIR-exposure (<=1). Propensity score and inverse probability weighting
were used to adjust for potential confounders. Further, we conducted a
nested case-control study to investigate if LDIR-exposure was predictive
of cancer using a multivariable logistic regression model. Each case was
matched on sex, CHD severity, age and calendar time with 4 randomly
selected controls. Results In over 250,791 person-years of follow-up, 602
cancer cases were observed. High LDIR-exposure was associated with a
2.6-fold increase risk of cancer (HR = 2.61, 95% CI: 2.30-2.96). In the
nested case-control study, cumulative LDIR-exposure was independently
associated with cancer (OR = 1.08 per procedure; 95% CI, 1.04-1.13).
Similar results were obtained using dose estimates (OR = 1.10 per 10
milliSieverts; 95% CI: 1.05-1.15) with an apparent dose-response
relationship. The effect measure was in the same direction after excluding
smoking-related cancer cases (OR = 1.10 per procedure; 95% CI: 1.05-1.16)
and after applying a three-year lag time (OR = 1.09 per procedure; 95% CI:
1.03-1.14). Conclusion To our knowledge, this is the first
population-based study to document the association between LDIR from
cardiac procedures and cancer in ACHD. This finding supports policy
recommendations for radiation surveillance in CHD patients where no
regulation currently exists.

<38>
Accession Number
620309532
Author
Nguyen L.; Squara P.; Amour J.; Cholley B.
Institution
(Nguyen, Squara) Critical Care Medicine Department, CMC Ambroise-Pare,
Neuilly-Sur-Seine, France
(Amour) Anesthesiology and Critical Care Medicine Department, AP-HP,
Pitie-Salpetriere, France
(Cholley) Anesthesiology and Critical Care Medicine Department, AP-HP,
HEGP, Paris, France
Title
Intravenous ivabradine in low cardiac output syndrome after cardiac
surgery treated by dobutamine: A phase II trial.
Source
Archives of Cardiovascular Diseases Supplements. Conference: 28es Journees
Europeennes de la Societe Francaise de Cardiologie, JESFC 2018. France. 10
(1) (pp 41), 2018. Date of Publication: January 2018.
Publisher
Elsevier Masson SAS
Abstract
Background Dobutamine is the first-line treatment for low cardiac output
syndrome (LCOS) after cardiac surgery, but induces sinus tachycardia. We
aimed to assess the intravenous (i.v.) ivabradine inpatients presenting
LCOS with dobutamine-induced tachycardia following elective coronary
artery bypass graft surgery. Methods In a phase 2 multicenter randomized
placebo-controlled trial, i.v. ivabradine was infused inpatients
presenting sinus tachycardia (heart rate (HR) > 100 bpm) after dobutamine
initiation. Primary endpoint was the number (%) of patients having their
HR reduced between 80 and 90 bpm for > 30 minutes. Secondary endpoints
were hemodynamic parameters measured by Swan-Ganz catheter. Results
Thirteen (93%) patients treated by ivabradine reached the primary
endpoint, compared to 2 (40%) in the placebo group (P < 0.05). Ivabradine
significantly decreased HR [112 to 86 bpm (P < 0.001)] while increasing
cardiac index [2.5 to 2.9 L/min/m2 (P < 0.05)], stroke volume [38.0 to
60.0mL (P < 0.001)] and systolic blood pressure [110 to 125mmHg (P <
0.05)]. These parameters remained similar in the placebo group. Five
(35.7%) patients developed atrial fibrillation in the ivabradine group
(Table 1, Fig. 1). Conclusion Intravenous ivabradine reduced HR inpatients
presenting with LCOS treated with dobutamine after CABG surgery, while
improving cardiac output. This beneficial effect should be confirmed with
larger trials.

<39>
Accession Number
620311259
Author
Cheng P.; Eksioglu E.; Guenot J.; Wei M.; Chen X.; Fox J.; List A.F.; Wei
S.
Institution
(Cheng, Wei, Chen) Moffitt Cancer Center, Tampa, FL, United States
(Eksioglu, List, Wei) Malignant Hematology, H. Lee Moffitt Cancer Center,
Tampa, FL, United States
(Guenot, Fox) Amphivena Therapeutics,Inc., San Francisco, CA, United
States
Title
Immunodepletion of MDSC By AMV564, a Novel Tetravalent Bispecific CD33/CD3
T Cell Engager Restores Immune Homeostasis in MDS in Vitro.
Source
Blood. Conference: 59th Annual Meeting of the American Society of
Hematology, ASH 2017. United States. 130 (Supplement 1) (no pagination),
2017. Date of Publication: December 2017.
Publisher
American Society of Hematology
Abstract
Myelodysplastic syndromes (MDS) are age-dependent and genetically diverse
hematopoietic neoplasms associated with inflammation, cytopenias, myeloid
dysplasia and risk for acute myeloid leukemia (AML) progression. Mounting
evidence indicates that emergence of somatic gene mutations arising in
hematopoietic stem and progenitor cells (HSPC) with age plays an important
role in MDS pathogenesis. Our investigations indicate that sustained
activation of innate immune response directs inflammation in the bone
marrow (BM) microenvironment that contributes to hematopoietic and immune
impairment through local generation of inflammatory cytokines, expansion
of regulatory T- cells, and up-regulation and activation of pattern
recognition receptors. Critical cellular effectors are the
inflammation-associated immature myeloid cells termed myeloid-derived
suppressor cells (MDSCs). Human MDSCs, distinguished phenotypically by
CD33<inf>high</inf> and HLA-DR^-Lin^- , expand and are
activated in cancers. We previously reported that MDSCs are profoundly
expanded in the local BM microenvironment of MDS where they contribute to
MDS hematopoietic BM failure. MDSCs suppress T-cell responses and impair
CD4⁺ /CD8⁺ function, suggesting that this may be a
key mechanism fostering clonal escape from antitumor immune response.
Indeed, the MDSC population size limits the benefit of immune checkpoint
antagonists in the treatment of solid tumors and effective strategies to
deplete MDSCs are lacking. Therefore, we hypothesized the high CD33
surface density in MDSCs can be exploited for selective immune-depletion
by the T-cell engager AMV564, a novel CD33/CD3 tetravalent bispecific
antibody that recognizes both CD33 and CD3, currently in clinical
development for AML (NCT03144245). Depletion of MDSCs may restore immune
function, hematopoiesis and improve sensitivity to checkpoint inhibitors.
Primary BM mononuclear cells (BMMNC) from 15 MDS patients were treated
with AMV564 or isotype IgG control for 5-7 days in vitro . AMV564
treatment of MDS BMMNC eliminated CD33⁺ MDSCs in a
dose-dependent manner and expanded CD4⁺ and CD8⁺
T-cells compared to controls (P <=0.001). Proliferation of CD4⁺
and CD8⁺ T-cells, measured by Brdu incorporation, more than
doubled with AMV564 treatment (P <=0.001). IFNgamma, a T-cell activation
biomarker, dramatically increased in AMV564 treated cells indicating
T-cells are fully activated by AMV564 at concentrations as low as 0.7
ng/ml (P <=0.01). Moreover, depletion of MDSCs and immunological
restoration was accompanied by significant improvement in colony-forming
capacity after AMV564 treatment (P <=0.01). Checkpoint inhibition alone
with 10 mug/ml of anti-PD1 antibody did not result in reduction of MDSCs
and T-cell activation in MDS BMMNCs, demonstrating that anti-PD1 alone is
insufficient to appropriately activate T-cells or modulate MDSC cell
number. Interestingly, combined treatment of MDS BMMNC with anti-PD1 and
AMV564 yielded more than additive T-cell activation and increased colony
forming capacity (P <=0.01), indicating the potential to augment
MDS-specific immune responses. Our findings demonstrate that AMV564
treatment selectively depletes MDSCs to reactivate T lymphocytes by
improving both quantity and quality of immune responses leading to the
improvement of hematopoiesis. These preclinical data provide a strong
rationale for clinical investigation of this innovative approach in
patients with MDS.

<40>
Accession Number
620307593
Author
Hua K.; Zhao Y.; Dong R.; Liu T.
Institution
(Hua, Zhao, Dong, Liu) Department of Cardiac Surgery, Beijing Institute of
Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
Title
Minimally invasive cardiac surgery in China: Multi-center experience.
Source
Medical Science Monitor. 24 (pp 421-426), 2018. Article Number: 905408.
Date of Publication: 22 Jan 2018.
Publisher
International Scientific Information, Inc. (E-mail:
iza.pranga@isl-science.com)
Abstract
Background: To the best of our knowledge, there is no nationwide data
available on the development of minimally invasive cardiac surgery (MICS)
in China. The purpose of this study was to report the results of MICS in 6
experienced centers in China. Material/Methods: From September 2014 to
July 2016, 1241 patients with cardiac conditions who underwent MICS
procedures were randomly enrolled in 6 centers in China, and those
patients were randomly selected for inclusion in this study. The MICS
procedures were defined as any cardiac surgery performed through a less
invasive incision, rather than a complete median sternotomy, mainly
including mini-incision surgery (400, 32.2%), video-assisted approach
(265, 21.3%), completely thoracoscopic approach without robotic assistance
(504, 40.6%), and robotic procedure (55, 4.4%). Results: The 5 most common
in-hospital complications were respiratory failure (28, 2.3%), reoperation
for all reasons (19, 1.5%), renal failure (11, 0.9%), heart failure (9,
0.7%), and stroke (6, 0.5%). The multivariate logistic regression analysis
results showed that cardiopulmonary bypass (CPB) time (P=0.033), aortic
cross-clamp time (P=0.003), cannulation approach (P=0.010), and left
ventricular ejection fraction (LVEF) (P=0.003) at baseline were all
significant risk factors of any in-hospital complication of MICS
procedures. Conclusions: From our experience, minimally invasive cardiac
approaches are safe and reproducible, with acceptable CPB and aortic
cross-clamp time duration and low mortality.<br/>Copyright &#xa9; Med Sci
Monit, 2018.

<41>
[Use Link to view the full text]
Accession Number
620336278
Author
Boese C.K.; Centeno L.; Walters R.W.
Institution
(Boese, Centeno, Walters) CHI Health Mercy Council Bluffs, Council Bluffs,
IA, United States
(Walters) Department of Medicine, Creighton University, Omaha, NE, United
States
Title
Blood Conservation Using Tranexamic Acid Is Not Superior to
Epsilon-Aminocaproic Acid after Total Knee Arthroplasty.
Source
Journal of Bone and Joint Surgery - American Volume. 99 (19) (pp
1621-1628), 2017. Date of Publication: 01 Oct 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background: Epsilon-aminocaproic acid (EACA) and tranexamic acid (TXA) are
synthetic amino acid derivatives that interfere with fibrinolysis,
promoting hemostasis by pharmacological means. Although both drugs have
been shown to decrease blood loss with a minimal risk of thromboembolic
adverse events following cardiac and vascular surgery, we are aware of
only 1 published trial that directly compared the antifibrinolytic effects
of EACA with those of TXA after total knee arthroplasty (TKA). The primary
aim of this prospective, randomized, controlled trial was to determine
whether TXA provides superior blood conservation following TKA compared
with that provided by EACA. Methods: A total of 194 patients scheduled to
undergo a primary unilateral TKA in the same community-based hospital were
prospectively randomized to receive intravenous EACA (n = 96) or TXA (n =
98). Both the patients and the operating surgeons were blinded to the
treatment assignments. Primary outcome measures included transfusions,
estimated blood loss, and the drop in the hemoglobin (Hgb) level.
Secondary outcomes measures included the change in the serum creatinine
level, postoperative complications, and length of hospital stay. Results:
Although the patients who received TXA averaged less estimated blood loss
than the patients who received EACA (t<inf>185</inf> = 2.18, p = 0.031;
mean difference = 144.2 mL, 95% confidence interval = 13.62 to 274.78 mL),
no transfusions were required in either group. We observed no
statistically significant or clinically relevant between-group differences
in the change in Hgb or serum creatinine level, postoperative
complications, or length of hospital stay. Conclusions: Although the
estimated blood loss was significantly greater in the EACA group, no
transfusions were required and no significant between-group differences
were observed for any other outcomes measured. We concluded that EACA may
be an acceptable alternative to TXA for blood conservation following TKA,
although replication of our results in noninferiority trials is necessary.
Level of Evidence: Therapeutic Level I. See Instructions for Authors for a
complete description of levels of evidence.<br/>Copyright &#xa9;2017 BY
THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED.

<42>
Accession Number
620193774
Author
Roeleveld P.P.; de Klerk J.C.A.
Institution
(Roeleveld) Department of Pediatric Intensive Care, Leiden University
Medical center, Leiden, Netherlands
(de Klerk) Department of Neonatal Intensive Care, Erasmus MC-Sophia
Children's Hospital, Rotterdam, Netherlands
Title
The Perspective of the Intensivist on Inotropes and Postoperative Care
Following Pediatric Heart Surgery: An International Survey and Systematic
Review of the Literature.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 9 (1) (pp
10-21), 2018. Date of Publication: 01 Jan 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Introduction: Inotropes are frequently being used in children undergoing
heart surgery to prevent or treat low cardiac output syndrome (LCOS).
There is only limited evidence that inotropes actually positively
influence postoperative outcome. Our aim was to describe the current
international practice variation in the use of inotropes following
congenital heart surgery. Methods: We developed an online survey regarding
the postoperative use of inotropes. We sent an invitation to all 197
registered members of the Pediatric Cardiac Intensive Care Society (PCICS)
to participate in the survey. We also performed a systematic review of the
literature. Results: Ninety-eight people (50%) responded, representing 62
international centers. Milrinone is routinely used perioperatively by 90
respondents (97%). Adrenaline/epinephrine is routinely used by 43%,
dopamine by 36%, dobutamine by 11%, and levosimendan by 6%. Steroids are
used routinely by 54% before initiating cardiopulmonary bypass.
Vasopressin is used by 44% of respondents. The development of LCOS is
monitored with lactate in 99% of respondents, physical examination (98%),
intermittent mixed venous saturation (76%), continuous mixed venous
saturation (13%), echocardiography (53%), core-peripheral temperature gap
(29%), near-infrared spectrometry (25%), and 4% use cardiac output
monitors (PiCCO, USCOM). To improve cardiac output, 42% add/increase
milrinone, 37% add adrenaline, and 15% add dopamine. Rescue therapy is
titrated individually, based on the patients' pathophysiology. A
systematic review of the literature failed to show compelling evidence
with regard to the benefit of inotropes. Conclusions: Despite the lack of
sufficient evidence, milrinone is used by the vast majority of caregivers
following congenital heart surgery.<br/>Copyright &#xa9; 2017, &#xa9; The
Author(s) 2017.

<43>
Accession Number
617493096
Author
Hage A.; Voisine P.; Erthal F.; Larose E.; Glineur D.; Chow B.; Tremblay
H.; Fortier J.; Ko G.; Une D.; Farkouh M.; Mesana T.G.; LeMay M.; Kulik
A.; Ruel M.
Institution
(Hage, Voisine, Tremblay) Division of Cardiac Surgery, Quebec Heart and
Lung Institute, Quebec City, Quebec, Canada
(Larose) Division of Cardiology, Quebec Heart and Lung Institute, Quebec
City, Quebec, Canada
(Erthal, Chow, LeMay) Division of Cardiology, University of Ottawa Heart
Institute, Ottawa, Ontario, Canada
(Glineur, Fortier, Ko, Mesana, Ruel) Division of Cardiac Surgery,
University of Ottawa Heart Institute, Ottawa, Ontario, Canada
(Une) Division of Cardiovascular Surgery, Yamato Seiwa Hospital, Yamato,
Japan
(Farkouh) Division of Cardiology, Mount Sinai Hospital, New York, NY,
United States
(Kulik) Division of Cardiovascular Surgery, Lynn Heart & Vascular
Institute, Boca Raton, Fla, United States
Title
Eight-year follow-up of the Clopidogrel After Surgery for Coronary Artery
Disease (CASCADE) trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (1) (pp 212-222.e2),
2018. Date of Publication: January 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective In this 8 years' follow-up study, we evaluated the long-term
outcomes of the addition of clopidogrel to aspirin during the first year
after coronary artery bypass grafting, versus aspirin plus placebo, with
respect to survival, major adverse cardiac, or major cerebrovascular
events, including revascularization, functional status, graft patency, and
native coronary artery disease progression. Methods In the initial
Clopidogrel After Surgery for Coronary Artery Disease trial, 113 patients
were randomized to receive either daily clopidogrel (n = 56) or placebo (n
= 57), in addition to aspirin, in a double-blind fashion for 1 year after
coronary artery bypass grafting. All patients were re-evaluated to collect
long-term clinical data. Surviving patients with a glomerular filtration
rate > 30 mL/min were asked to undergo a coronary computed tomography
angiogram to evaluate the late saphenous vein graft patency and native
coronary artery disease progression. Results At a median follow-up of 7.6
years, survival rate was 85.5% +/- 3.8% (P =.23 between the 2 groups). A
trend toward enhanced freedom from all-cause death or major adverse
cardiac or cerebrovascular events, including revascularization, was
observed in the aspirin-clopidogrel group (P =.11). No difference in
functional status or freedom from angina was observed between the 2 groups
(P >.57). The long-term patency of saphenous vein graft was 89.11% in the
aspirin-clopidogrel group versus 91.23% in the aspirin-placebo group (P
=.79). A lower incidence of moderate to severe native disease progression
was observed in the aspirin-clopidogrel group versus the aspirin-placebo
group (7 out of 122 vs 13 out of 78 coronary segments that showed
progression, respectively [odds ratio, 0.3 +/- 0.2; 95% confidence
interval, 0.1-0.8; P =.02]). Conclusions At 8 years' follow-up, the
addition of clopidogrel to aspirin during the first year after coronary
artery bypass grafting exhibited a lower incidence of moderate to severe
progression of native coronary artery disease and a trend toward higher
freedom from major adverse cardiac or cerebrovascular events, including
revascularization, or death in the aspirin-clopidogrel group. Clinical
Trial Registration http://www.clinicaltrials.gov. Unique identifier:
NCT00228423.<br/>Copyright &#xa9; 2017 The American Association for
Thoracic Surgery

<44>
Accession Number
620283289
Author
Bob-Manuel T.; Kadire S.; Heckle M.R.; Wang J.; Ibebuogu U.N.
Institution
(Bob-Manuel, Kadire, Heckle, Ibebuogu) Division of Cardiovascular
Diseases, Department of Medicine, University of Tennessee Health Science
Center, Methodist University Hospital, Memphis, TN, United States
(Wang) Division of Biostatistics and Epidemiology, Department of
Preventive Medicine, University of Tennessee Health Science Center,
Memphis, TN, United States
Title
Outcomes following transcatheter aortic valve replacement in patients with
native aortic valve regurgitation.
Source
Annals of Translational Medicine. 6 (1) (no pagination), 2018. Article
Number: 8. Date of Publication: January 2018.
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Due to the absence of annular calcification for device anchoring, it is
presumed that transcatheter aortic valve replacement (TAVR) is not
suitable for the treatment of native aortic valve regurgitation (NAVR)
resulting in very limited data and experience concerning its safety and
efficacy. We sought to review published data on the safety and efficacy of
TAVR in high-risk patients with NAVR. Studies including case reports, case
series and original articles published between 2002 and 2016 on TAVR in
patients with NAVR were identified with a systematic electronic search
using the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) statement. Only studies reporting data on
demographic and procedural characteristics, management and follow up
outcomes were analyzed. A total of 30 publications describing 182 patients
were identified. Most patients (54%) were men, with a mean age of
70.1+/-2.6 years, mean logistic European System for Cardiac Operative Risk
Evaluation score (EuroSCORE) of 21.8%+/-4.5% and mean Society of Thoracic
Surgeons (STS) score of 8%+/-1.8% for mortality. The majority (87%) of
patients had severe NAVR with no valvular calcification. TAVR was mostly
performed through the femoral (58.8%) and apical (33.1%) approach. Device
success, defined by VARC-2, was achieved in 86.3% of our study population.
A second valve was required in 17 patients (9.3%) during the index
procedure for residual aortic regurgitation or malposition. Post-procedure
aortic regurgitation of grade 1 or less was present in 80 patients (81%).
Pacemaker implantation was required post procedure in 17 patients (9.3%).
The 30-day and 1-year mortality was 11.9% and 16.2%, respectively. TAVR is
associated with favorable pacemaker implantation and 1-year mortality
rates with a high 30-day mortality among selected patients with
NAVR.<br/>Copyright &#xa9; Annals of Translational Medicine.

<45>
Accession Number
618500434
Author
Filardo G.; Hamman B.L.; da Graca B.; Sass D.M.; Machala N.J.; Ismail S.;
Pollock B.D.; Collinsworth A.W.; Grayburn P.A.
Institution
(Filardo, Sass, Machala, Ismail, Pollock) Department of Epidemiology,
Baylor Scott & White Health, Dallas, Tex, United States
(da Graca, Collinsworth) Center for Clinical Effectiveness, Baylor Scott &
White Health, Dallas, Tex, United States
(Filardo, da Graca, Pollock, Collinsworth) Robbins Institute for Health
Policy and Research, Baylor University, Waco, Tex, United States
(Filardo) Department of Statistics, Southern Methodist University, Dallas,
Tex, United States
(Hamman) Department of Cardiothoracic Surgery, Baylor Heart and Vascular
Institute, Baylor University Medical Center, Dallas, Tex, United States
(Grayburn) Department of Cardiology, Baylor Heart and Vascular Institute,
Baylor University Medical Center, Dallas, Tex, United States
Title
Efficacy and effectiveness of on- versus off-pump coronary artery bypass
grafting: A meta-analysis of mortality and survival.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (1) (pp 172-179.e5),
2018. Date of Publication: January 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Despite many studies comparing on- versus off-pump coronary
artery bypass graft (CABG), there is no consensus as to whether one of
these techniques offers patients better outcomes. Methods We searched
PubMed from inception to June 30, 2015, and identified additional studies
from bibliographies of meta-analyses and reviews. We identified 42
randomized controlled trials (RCTs) and 31 rigorously adjusted
observational studies (controlling for the Society of Thoracic
Surgeons-recognized risk factors for mortality) reporting mortality for
off-pump versus on-pump CABG at specified time points. Trial data were
extracted independently by 2 researchers using a standardized form.
Differences in probability of mortality (DPM) were estimated for the RCTs
and observational studies separately and combined, for time points ranging
from 30 days to 10 years. Results RCT-only data showed no significant
differences at any time point, whereas observational-only data and the
combined analysis showed short-term mortality favored off-pump CABG (n =
1.2 million patients; 36 RCTs, 26 observational studies; DPM [95%
confidence interval (CI)], -44.8% [-45.4%, -43.8%]) but that at 5 years it
was associated with significantly greater mortality (n = 60,405 patients;
3 RCTs, 5 observational studies; DPM [95% CI], 10.0% [5.0%, 15.0%]). At 10
years, only observational data were available, and off-pump CABG showed
significantly greater mortality (DPM [95% CI], 14.0% [11.0%, 17.0%]).
Conclusions Evidence from RCTs showed no differences between the
techniques, whereas rigorously adjusted observational studies (with >1.1
million patients) and the combined analysis indicated that off-pump CABG
offers lower short-term mortality but poorer long-term survival. These
results suggest that, in real-world settings, greater operative safety
with off-pump CABG comes at the expense of lasting survival
gains.<br/>Copyright &#xa9; 2017 The American Association for Thoracic
Surgery

<46>
Accession Number
618483110
Author
Mazine A.; Friedrich J.O.; Nedadur R.; Verma S.; Ouzounian M.; Juni P.;
Puskas J.D.; Yanagawa B.
Institution
(Mazine, Nedadur, Verma, Yanagawa) Division of Cardiac Surgery, Department
of Surgery, St Michael's Hospital, University of Toronto, Toronto,
Ontario, Canada
(Friedrich) Department of Critical Care Medicine, St Michael's Hospital,
University of Toronto, Toronto, Ontario, Canada
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute, St
Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
(Ouzounian) Division of Cardiac Surgery, Department of Surgery, Peter Munk
Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto,
Ontario, Canada
(Puskas) Department of Cardiothoracic Surgery, Mount Sinai Saint Luke's,
New York, NY, United States
Title
Systematic review and meta-analysis of chordal replacement versus leaflet
resection for posterior mitral leaflet prolapse.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (1) (pp 120-128.e10),
2018. Date of Publication: January 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives To compare outcomes of chordal replacement versus leaflet
resection techniques for repair of isolated posterior mitral leaflet
prolapse. Methods We searched MEDLINE and EMBASE databases for studies
that compared chordal replacement ("neo-chord" group) versus leaflet
resection ("resection" group) techniques for the treatment of posterior
mitral leaflet prolapse. Data were extracted by 2 independent
investigators and subjected to a meta-analysis using a random-effects
model. Results One randomized controlled trial (RCT), 1 propensity-matched
study, and 6 unadjusted observational studies, with a total of 1926
patients, met our inclusion criteria. Two studies reported only
perioperative outcomes; mean follow-up ranged from 1.0 to 5.9 years in the
remaining studies. In pooled data from unadjusted observational studies,
annuloplasty ring diameter was higher in the neo-chord group (+1.5 mm; P
=.0003), but with high heterogeneity (I² = 91%). Based on
limited data, postprocedural left ventricular ejection fraction may be
greater in the neo-chord group, but this difference reached statistical
significance only in the RCT (+3.4%; P =.03), and not in 2 observational
studies that reported this outcome (+2.7%; P =.10). There was no
difference in recurrent mitral regurgitation at follow-up between the
resection and neo-chord groups; however, patients in the neo-chord group
had a lower rate of mitral valve reoperation at follow-up in the
unadjusted observational studies (incidence rate ratio, 0.22; P =.0008
[I² = 0%; 4 studies, 1331 patients]). Conclusions Chordal
replacement may be associated with greater freedom from reoperation and
may lead to improved postoperative left ventricular function compared with
leaflet resection. However, these conclusions are supported primarily by
data from unadjusted observational studies, and high-quality RCTs of
chordal replacement versus leaflet resection are needed.<br/>Copyright
&#xa9; 2017 The American Association for Thoracic Surgery

<47>
[Use Link to view the full text]
Accession Number
620308068
Author
Besch G.; Perrotti A.; Mauny F.; Puyraveau M.; Baltres M.; Flicoteaux G.;
Du Mont L.S.; Barrucand B.; Samain E.; Chocron S.; Pili-Floury S.
Institution
(Besch, Baltres, Flicoteaux, Barrucand, Samain, Pili-Floury) Department of
Anesthesiology and Intensive Care Medicine, University of Franche-Comte, 3
Boulevard Alexander Fleming, Besancon F-25000, France
(Besch, Perrotti, Du Mont, Samain, Chocron, Pili-Floury) EA 3920,
University of Franche-Comte, Besancon, France
(Perrotti, Chocron) Department of Cardiothoracic Surgery, University of
Franche-Comte, Besancon, France
(Mauny, Puyraveau) Clinical Methodology Center, University of
Franche-Comte, Besancon, France
(Du Mont) Department of Vascular Surgery, University of Franche-Comte,
Besancon, France
(Mauny) University Hospital of Besancon, Chronoenvironement Laboratory,
UMR6249 CNRS, University of Franche-Comte, Besancon, France
(Samain, Pili-Floury) SFR-FED 4234 INSERM, University of Franche-Comte,
Besancon, France
Title
Clinical Effectiveness of Intravenous Exenatide Infusion in Perioperative
Glycemic Control after Coronary Artery Bypass Graft Surgery: A Phase
II/III Randomized Trial.
Source
Anesthesiology. 127 (5) (pp 775-787), 2017. Date of Publication: 01 Nov
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: We aimed to assess the clinical effectiveness of intravenous
exenatide compared to insulin in perioperative blood glucose control in
coronary artery bypass grafting surgery patients. Methods: Patients more
than 18 yr old admitted for elective coronary artery bypass grafting were
included in a phase II/III nonblinded randomized superiority trial.
Current insulin use and creatinine clearance of less than 60 ml/min were
exclusion criteria. Two groups were compared: the exenatide group,
receiving exenatide (1-h bolus of 0.05 mug/min followed by a constant
infusion of 0.025 mug/min), and the control group, receiving insulin
therapy. The blood glucose target range was 100 to 139 mg/dl. The primary
outcome was the proportion of patients who spent at least 50% of the study
period within the target range. The consumption of insulin
(C<inf>insulin</inf>) and the time to start insulin (T<inf>insulin</inf>)
were compared between the two groups. Results: In total, 53 and 51
patients were included and analyzed in the exenatide and control groups,
respectively (age: 70 +/- 9 vs. 68 +/- 11 yr; diabetes mellitus: 12 [23%]
vs. 10 [20%]). The primary outcome was observed in 38 (72%) patients in
the exenatide group and in 41 (80%) patients in the control group (odds
ratio [95% CI] = 0.85 [0.34 to 2.11]; P = 0.30). C<inf>insulin</inf> was
significantly lower (60 [40 to 80] vs. 92 [63 to 121] U, P < 0.001), and
T<inf>insulin</inf> was significantly longer (12 [7 to 16] vs. 7 [5 to 10]
h, P = 0.02) in the exenatide group. Conclusions: Exenatide alone at the
dose used was not enough to achieve adequate blood glucose control in
coronary artery bypass grafting patients, but it reduces overall
consumption of insulin and increases the time to initiation of
insulin.<br/>Copyright &#xa9; 2017, the American Society of
Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved.

<48>
[Use Link to view the full text]
Accession Number
620315103
Author
Frisoli T.M.; Nowak R.; Evans K.L.; Harrison M.; Alani M.; Varghese S.;
Rahman M.; Noll S.; Flannery K.R.; Michaels A.; Tabaku M.; Jacobsen G.;
McCord J.
Institution
(Frisoli, Tabaku, McCord) Heart and Vascular Institute, K14 Henry Ford
Hospital, Detroit, MI 48202, United States
(Nowak, Harrison, Noll, Flannery) Department of Emergency Medicine, United
States
(Evans, Alani, Varghese, Rahman, Michaels) Department of Internal
Medicine, United States
(Jacobsen) Biostatistics Division, Department of Public Health Sciences,
Henry Ford Hospital, Detroit, MI, United States
Title
Henry Ford HEART Score Randomized Trial: Rapid Discharge of Patients
Evaluated for Possible Myocardial Infarction.
Source
Circulation: Cardiovascular Quality and Outcomes. 10 (10) (no pagination),
2017. Date of Publication: 01 Oct 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background-Hospital evaluation of patients with chest pain is common and
costly. The HEART score risk stratification tool that merges troponin
testing into a clinical risk model for evaluation emergency department
patients with possible acute myocardial infarction (AMI) has been shown to
effectively identify a substantial low-risk subset of patients possibly
safe for early discharge without stress testing, a strategy that could
have tremendous healthcare savings implications. Method and Results-A
total of 105 patients evaluated for AMI in the emergency departments of 2
teaching hospitals in the Henry Ford Health System (Detroit and West
Bloomfield, MI), between February 2014 and May 2015, with a modified HEART
score <=3 (which includes cardiac troponin I <0.04 ng/mL at 0 and 3 hours)
were randomized to immediate discharge (n=53) versus management in an
observation unit with stress testing (n=52). The primary end points were
30-day total charges and length of stay. Secondary end points were
all-cause death, nonfatal AMI, rehospitalization for evaluation of
possible AMI, and coronary revascularization at 30 days. Patients
randomized to early discharge, compared with those who were admitted for
observation and cardiac testing, spent less time in the hospital (median
6.3 hours versus 25.9 hours; P<0.001) with an associated reduction in
median total charges of care ($2953 versus $9616; P<0.001). There were no
deaths, AMIs, or coronary revascularizations in either group. One patient
in each group was lost to follow-up. Conclusions-Among patients evaluated
for possible AMI in the emergency department with a modified HEART score
<=3, early discharge without stress testing as compared with transfer to
an observation unit for stress testing was associated with significant
reductions in length of stay and total charges, a finding that has
tremendous potential national healthcare expenditure implications.
Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique
identifier: NCT03058120.

<49>
[Use Link to view the full text]
Accession Number
620314329
Author
Thomaidou E.; Argiriadou H.; Vretzakis G.; Megari K.; Taskos N.;
Chatzigeorgiou G.; Anastasiadis K.
Institution
(Thomaidou, Argiriadou) Department of Anesthesia and Intensive Care,
Aristotle University of Thessaloniki, AHEPA University Hospital, 1st
Kyriakidi str, Thessaloniki 546 36, Greece
(Vretzakis) Department of Anesthesia, University of Thessaly, Larisa,
Greece
(Megari) Laboratory of Cognitive Neuroscience, School of Psychology,
Thessaloniki, Greece
(Taskos) 1st Neurology Department, Aristotle University of Thessaloniki,
Thessaloniki, Greece
(Chatzigeorgiou) Neurology Department, University of Thessaly, Larisa,
Greece
(Anastasiadis) Cardiothoracic Department, Aristotle University of
Thessaloniki, Thessaloniki, Greece
Title
Perioperative Use of Erythromycin Reduces Cognitive Decline after Coronary
Artery Bypass Grafting Surgery: A Pilot Study.
Source
Clinical Neuropharmacology. 40 (5) (pp 195-200), 2017. Date of
Publication: 01 Sep 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives Adverse neurologic outcome can be a debilitating complication
after cardiac surgery. The aim of this study was to investigate the
potential neuroprotective action of erythromycin, a well known antibiotic
agent, regarding postoperative cognitive decline in patients undergoing
cardiac surgery. Methods Forty patients scheduled for elective coronary
artery bypass grafting surgery were prospectively randomly assigned in 2
groups: the erythromycin group (n = 19) who received erythromycin at a
dose of 25 mg/kg before and after surgery and the control group (n = 21)
who did not receive it. All patients were monitored with near-infrared
spectroscopy during the operation. Interleukin (IL) 1 and IL-6 as
inflammatory markers and tau protein as a marker of brain injury were
measured before and after surgery. Neurocognitive assessment was performed
before surgery, on the day of discharge, and at 3 months postoperatively.
Results Both groups were comparable in terms of demographic and clinical
data. Patients who took erythromycin presented with significantly better
cognitive performance before discharge and 3 months after surgery. No
significant differences between the 2 groups referring to IL-1 and IL-6
values were detected. Tau serum values were lower in the erythromycin
group after surgery. Conclusions Erythromycin administration attenuates
cerebral damage and postoperative cognitive decline after coronary artery
bypass grafting surgery. Trial registration The study was retrospectively
registered at ClinicalTrials.gov (NCT01274754). Study start day: November
2008.<br/>Copyright &#xa9; 2017 Wolters Kluwer Health, Inc. All rights
reserved.

<50>
Accession Number
620260595
Author
Konstantelias A.A.; Andriakopoulou C.S.; Mourgela S.
Institution
(Konstantelias, Andriakopoulou, Mourgela) a Department of Neurosurgery ,
Agios Savvas Cancer Hospital , Athens , Greece
Title
Triclosan-coated sutures for the prevention of surgical-site infections: a
meta-analysis.
Source
Acta chirurgica Belgica. 117 (3) (pp 137-148), 2017. Date of Publication:
01 Jun 2017.
Abstract
RESULTS: The meta-analysis of 30 studies (19 randomized, 11
non-randomized; 15,385 procedures) gave evidence that TCS were associated
with a lower risk of SSIs (risk ratio [RR]=0.68; 95% confidence interval
[CI] 0.57-0.81). Triclosan-coated sutures were associated with lower risk
for SSIs in high-quality randomized studies (Jadad score 4 or 5). A lower
risk for the development of SSIs based on wound classification was
observed in clean, clean-contaminated, and contaminated but not for dirty
procedures. No benefit was observed in specific types of surgery:
colorectal, cardiac, lower limb vascular or breast surgery. Only a trend
was found for lower risk for wound dehiscence, whereas no difference was
observed for all-cause mortality.
CONCLUSIONS: Further randomized studies are needed to confirm the role of
TCS in specific surgical procedures and whether or not they are related
with lower risk for mortality.
BACKGROUND: The scope of this article is to perform a meta-analysis of the
studies that compare the use of triclosan-coated sutures (TCS) to uncoated
sutures in prevention of surgical-site infections (SSIs).
METHODS: A systematic search of randomized and non-randomized studies was
carried out on Pubmed and Scopus databases until July 2016.

<51>
Accession Number
620328042
Author
Ding N.; Zhou N.; Li Q.; Ren G.; Zhou M.
Institution
(Ding, Zhou, Li, Ren, Zhou) Department of Respiratory Medicine, The
Affiliated Xuzhou City Hospital of Xuzhou Medical University, Xuzhou,
Jiangsu 221002, China
Title
Analysis of middle- and long-term efficacy of thoracoscope-assisted
segmental resection of the lung on non-small cell lung cancer in the early
stage.
Source
Oncology Letters. 15 (3) (pp 3662-3668), 2018. Date of Publication: March
2018.
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece.
E-mail: subscriptions@spandidos-publications.com)
Abstract
We investigated the short- and long-term efficacy of thoracoscope-assisted
segmental resection of lung of non-small cell lung cancer (NSCLC). We
selected a total of 94 patients with lung cancer in the early stage who
were admitted to The First People's Hospital of Xuzhou for treatment
between March 2011 and February 2012. Patients were divided randomly into
either the control group (n=47) or the observation group (n=47). In the
observation group, patients received thoracoscope-assisted segmental
resection of lung, while in the control group, the conventional thoracic
surgery was performed for treatment. After surgeries, we observed the
incidence rate of complications among the two groups, and enzyme-linked
immunosorbent assay (ELISA) was adopted to detect levels of inflammatory
factors. We also compared the cardiac and pulmonary functions, the levels
of immunoglobulins and subgroups of T lymphocytes in the peripheral blood
of the patients. In addition, all patients attended a 5-year follow-up to
determine the recurrence and survival rate. Compared to the control group,
patients in the observation group had significantly less intra-operative
bleeding volume, a shorter duration of surgery, and suffered slighter pain
after surgery (P<0.05). After surgery, the incidence rate of complications
in the observation group was significantly lower than that in the control
group (P<0.05). After surgeries, patients in both groups experienced a
remarkable improvement in cardiac and pulmonary functions, and the
improvement in the observation group was superior to that of the control
group (P<0.05). During the 5-year follow-up, the survival rate of the
observation group is significantly higher than that in thecontrol group,
and patients in the observation group experienced a lower recurrence rate
than those in the control group (P<0.05). Thus, thoracoscope-assisted
segmental resection of lung is of great significance in clinical
practice.<br/>Copyright &#xa9; 2018, Spandidos Publications. All rights
reserved.

<52>
Accession Number
620245810
Author
Liu Y.; Sheng B.; Wang S.; Lu F.; Zhen J.; Chen W.
Institution
(Liu, Sheng, Wang, Lu, Zhen, Chen) Capital Medical University, Department
of Intensive care unit, Beijing Shijitan Hospital, No. 10, Tieyi Road,
Haidian District, Beijing 100038, China
Title
Dexmedetomidine prevents acute kidney injury after adult cardiac surgery:
A meta-analysis of randomized controlled trials.
Source
BMC Anesthesiology. 18 (1) (no pagination), 2018. Article Number: 7. Date
of Publication: 15 Jan 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Dexmedetomidine has been shown to confer direct renoprotection
by stabilizing the sympathetic system, exerting anti-inflammatory effects
and attenuating ischemia/reperfusion (I/R) injury in preclinical studies.
Results from clinical trials of dexmedetomidine on acute kidney injury
(AKI) following adult cardiac surgery are controversial. Methods: We
searched EMBASE, PubMed, and Cochrane CENTRAL databases for randomized
controlled trials (RCTs) comparing the renal effect of dexmedetomidine
versus placebo or other anesthetic drugs in adult patients undergoing
cardiac surgery. The primary outcome was the incidence of AKI. The
secondary outcomes were mechanical ventilation (MV) duration, intensive
care unit (ICU) stay and hospital length of stay(LOS), and postoperative
mortality (in-hospital or within 30 days). Results: Ten trials with a
total of 1575 study patients were selected. Compared with controls,
dexmedetomidine significantly reduced the incidence of postoperative AKI
[68/788 vs 97/787; odds ratio(OR), 0.65; 95% confidence interval (CI),
0.45-0.92; P = 0.02; I² = 0.0%], and there was no difference
between groups in postoperative mortality (4/487 vs 11/483; OR, 0.43; 95%
CI, 0.14-1.28; P = 0.13; I² = 0.0%), MV duration [in days; n =
1229; weighted mean difference(WMD), -0.22; 95% CI, -2.04 to 1.70; P =
0.81], ICU stay (in days; n = 1363; WMD, -0.85; 95% CI, -2.14 to 0.45; P =
0.20), and hospital LOS (in days; n = 878; WMD, -0.24; 95% CI, -0.71 to
0.23; P = 0.32). Conclusions: Perioperative administration of
dexmedetomidine in adult patients undergoing cardiac surgery may reduce
the incidence of postoperative AKI. Future trials are needed to determine
the dose and timing of dexmedetomidine in improving outcomes, especially
in patients with decreased baseline kidney function.<br/>Copyright &#xa9;
2018 The Author(s).

<53>
Accession Number
620226443
Author
Sane S.; Khoshkbary M.; Abbasyvash R.; Mahoori A.R.
Institution
(Sane, Khoshkbary, Abbasyvash, Mahoori) Department of Anesthesiology,
Urmia University of Medical Sciences, Urmia, Iran, Islamic Republic of
Title
Evaluation of the effect of preoperative oral Tizanid in on the rate of
anesthetic consumption & hemodynamic changes in Tiva (total intravenous
anesthesia).
Source
Journal of Global Pharma Technology. 8 (12) (pp 441-446), 2016. Date of
Publication: 2016.
Publisher
Journal of Global Pharma Technology (E-mail: shweta11982@gmail.com)
Abstract
Objective: Materials and Methods: A double-blind clinical trial has been
performed on 50 candidates for elective laparoscopic colecystectomy
undergoing general anesthesia in Educational Hospital of Imam Khomeiny
uromieh, Iran. 25 randomly selected patients (the case group) were given 4
mg of oral Tizanidine 90 minutes before the induction of anesthesia
whereas the remaining subjects (the control group) were given placebo.
Bispectral index "BIS" level before induction and after Tizanid in
premedication, Induction time(Time of bispectral index "BIS" to reach 60),
Mean arterial pressure and heart rate before and after induction of
anesthesia, and after intubation and 10 min after peritoneal gas
insufflations and in intraoperative period and after extubation, and the
needed Propofol & Remifentanyl dosage were measured and recorded. Data
analysis was done with T-test and Chi-squared test, using SPSS software
version 19.Results: BIS level before induction and after tizanidin
premedication was 91.04+/-1.13 & 94.56+/-1.82 in control and case group
respectively (p valu<0.01). Induction time was 56.9+/-5.35 and 80.2+/-2.9
seconds in control and case group respectively (p valu<0.009). Average
propofol & remifentanyl needed dose for anesthesia maintenance in case
group was 28.95% & 33.3% less than the needed amount in the control group
respectively. There is no difference in mean arterial pressure and heart
rate before and after induction of anesthesia between the two groups.
Variations of mean arterial pressure and heart rate after intubation and
10 min after peritoneal gas insufflations and in intraoperative period and
after extubation, were less in Tizanidine group generally. Conclusions:
Using oral Tizanidine as a premedication decreased BIS level & diminished
induction time of anesthesia decreased required Propofol and remifentanyl
& yielded stability in mean arterial pressure and heart rate during
surgery. Considering its short duration of action, Tizanidine use as a
premedication is recommended for sedation and stabilization of hemodynamic
responses during the operations.<br/>Copyright &#xa9; 2009-2016, JGPT.

<54>
Accession Number
613223949
Author
Poulin M.-F.; Deka A.; Mohamedali B.; Schaer G.L.
Institution
(Poulin) Division of Cardiovascular Medicine, Department of Medicine, Beth
Israel Deaconess Medical Center, Boston, MA, United States
(Deka, Mohamedali, Schaer) Division of Cardiology, Department of Medicine,
Rush University Medical Center, Chicago, IL, United States
Title
Clinical benefits of stem cells for chronic symptomatic systolic heart
failure: A systematic review of the existing data and ongoing trials.
Source
Cell Transplantation. 25 (11) (pp 1911-1923), 2016. Date of Publication:
2016.
Publisher
Cognizant Communication Corporation (3 Hartsdale Road, Elmsford NY
10523-3701, United States)
Abstract
The benefits of stem cell therapy for patients with chronic symptomatic
systolic heart failure due to ischemic and nonischemic cardiomyopathy (ICM
and NICM, respectively) are unclear. We performed a systematic review of
major published and ongoing trials of stem cell therapy for systolic heart
failure and compared measured clinical outcomes for both types of
cardiomyopathy. The majority of the 29 published studies demonstrated
clinical benefits of autologous bone marrow-derived mesenchymal stem cells
(BM-MSCs). Left ventricular ejection fraction (LVEF) was improved in the
majority of trials after therapy. Cell delivery combined with coronary
artery bypass grafting was associated with the greatest improvement in
LVEF. Left ventricular end-systolic volume (or diameter), New York Heart
Association functional classification, quality of life, and exercise
capacity were also improved in most studies after cell therapy. Most ICM
trials demonstrated a significant improvement in perfusion defects,
infarct size, and myocardial viability. Several larger clinical trials
that are in progress employ alternative delivery modes, cell types, and
longer follow-up periods. Stem cells are a promising therapeutic modality
for patients with heart failure due to ICM or NICM. More data are required
from larger blinded trials to determine which combination of cell type and
delivery mode will yield the most benefit with avoidance of harm in these
patient populations.<br/>Copyright &#xa9; 2016 Cognizant, LLC.

<55>
Accession Number
620162110
Author
Chen H.S.; Wang W.; Wu S.N.; Liu J.P.
Institution
(Chen) The Second Affiliated Hospital of Ji Nan University, Intensive Care
Unit, Shenzhen People's Hospital, 1017 Dong Men Bei Lu, Shenzhen City,
Guangdong, Luo Hu District 518020, China
(Wang) Shenzhen People's Hospital, Endocrinology, No 1017, Dong Men North
Rd, Shenzhen City, Luohu District 518020, China
(Wu) Shenzhen People's Hospital, The Second Affiliated Hospital of Ji Nan
University, Intensive Care Unit, No.1017 Dong Men Bei Lu, Shenzhen City,
GuangDong Province, Luo Hu District 518020, China
(Liu) Beijing University of Chinese Medicine, Centre for Evidence-Based
Chinese Medicine, 11 Bei San Huan Dong Lu, Beijing, Chaoyang District
100029, China
Title
Corticosteroids for viral myocarditis.
Source
Cochrane Database of Systematic Reviews. 2013 (10) (no pagination), 2013.
Article Number: CD004471. Date of Publication: 18 Oct 2013.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Myocarditis is defined as inflammation of the myocardium
accompanied by myocellular necrosis. Experimental evidence suggests that
autoimmune mechanisms follow viral infection, resulting in inflammation
and necrosis in the myocardium. However, the use of corticosteroids as
immunosuppressives for this condition remains controversial. Objectives:
The existing review was updated. The primary objective of this review is
to assess the beneficial and harmful effects of treating acute or chronic
viral myocarditis with corticosteroids. The secondary objective is to
determine the best dose regimen. Search methods: We searched the Cochrane
Central Register of Controlled Trials (CENTRAL, Issue 7 of 12, 2012) on
The Cochrane Library, MEDLINE OVID (1946 to July Week 2, 2012), EMBASE
OVID (1980 to Week 29, 2012), BIOSIS Previews (1969 to 20 July 2012), ISI
Web of Science (1970 to 20th July, 2012), and LILACS (from its inception
to 25 July, 2012) , Chinese Biomed Database, CNKI and WANFANG Databases
(from their inception to 31 December 2012). We applied no language
restrictions. Selection criteria: Randomised controlled trials (RCTs) of
corticosteroids for viral myocarditis compared with no intervention,
placebo, supportive therapy, antiviral agents therapy or conventional
therapy, including trials of corticosteroids plus other treatment versus
other treatment alone, irrespective of blinding, publication status, or
language. Data collection and analysis: Two review authors extracted data
independently. Results were presented as risk ratios (RRs) and mean
differences (MDs), both with 95% confidence intervals (CIs). Main results:
Eight RCTs (with 719 participants) were included in this update. The
trials were small in size and methodological quality was poor. Viral
detection was performed in 38% of participants, among whom 56% had
positive results. Mortality between corticosteroids and control groups was
non-significant (RR, 0.93, 95% CI 0.70 to 1.24). At 1 to 3 months
follow-up, left ventricular ejection fraction (LVEF) was higher in the
corticosteroids group compared to the control group (MD 7.36%, 95% CI 4.94
to 9.79), but there was substantial heterogeneity. Benefits were observed
in LVEF in two trials with 200 children given corticosteroids (MD 9.00%,
95% CI 7.48 to 10.52). New York Heart Association (NYHA) class and left
ventricular end-stage systole diameter (LVESD) were not affected. Creatine
phosphokinase (CPK) (MD -104.00 U/L, 95% CI -115.18 to -92.82), Isoenzyme
of creatine phosphate MB (CKMB) (MD 10.35 U/L, 95% CI 8.92 to 11.78), were
reduced in the corticosteroids group compared to the control group,
although the evidence is limited to small participant numbers. There were
insufficient data on adverse events. Authors' conclusions: For people
diagnosed with viral myocarditis and low LVEF, corticosteroids do not
reduce mortality. They may improve cardiac function but the trials were of
low quality and small size so this finding must be regarded as uncertain.
High-quality, large-scale RCTs should be careful designed to determine the
role of corticosteroid treatment for viral myocarditis. Adverse events
should also be carefully evaluated.<br/>Copyright &#xa9; 2013 The Cochrane
Collaboration. Published by John Wiley & Sons, Ltd.

<56>
Accession Number
620308544
Author
Hernandez E.G.; Perez A.R.; Gilard J.F.; Alamo M.N.M.; Socorro M.E.;
Suarez P.R.; Esquinas A.M.
Institution
(Hernandez, Perez) Anesthesiology Service, Hospital Universitario de Gran
Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain
(Gilard, Suarez) Thoracic Surgery Service, Hospital Universitario de Gran
Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain
(Perez, Gilard) Department of Medical and Surgical Sciences, School of
Medicine, University of Las Palmas de Gran Canaria, Spain
(Alamo, Socorro) Physical Medicine and Rehabilitation Service, Hospital
Universitario de Gran Canaria, Doctor Negrin, Spain
(Esquinas) Intensive Care and Non Invasive Ventilatory Unit, Hopital
Morales Meseguer, Murcia, Spain
Title
Prophylactic use of non-invasive mechanical ventilation in lung resection.
Source
European Review for Medical and Pharmacological Sciences. 22 (1) (pp
190-198), 2018. Date of Publication: 2018.
Publisher
Verduci Editore s.r.l (E-mail: g.lombardi@verduci.it)
Abstract
OBJECTIVE: To evaluate if the prophylactic application of BiPAP previous
to lung resection and 17 hours postoperatively improves respiratory
function. In order to do this, we studied the results of arterial blood
gases and portable spirometry in the immediate postoperative period and at
the first and third postoperative day. Secondary objectives included
evaluating whether this same pattern decreases the incidence of
postoperative pulmonary complications (PPC) and hospital stay. PATIENTS
AND METHODS: This was a prospective, randomized clinical study. Between
January 2012 and June 2013, 50 patients who had undergone lung resection
with posterolateral thoracotomy were assigned to one of two groups by a
random number generator according to whether or not they would receive
prophylactic BiPAP pre- and postoperatively. RESULTS: The results of the
gasometric and spirometric values were similar in both groups. There were
no statistically significant differences (p > 0.05). There was not a
decrease in the incidence of PPC in the group that received prophylactic
BiPAP. Likewise, postoperative stay was similar in both groups. The BiPAP
group was 6.60 +/- 4 days and the non BiPAP group was 6.84 +/- 3.94 days
(p = 0.63). CONCLUSIONS: One drawback of this work was the limited number
of hours that BiPAP was employed, and when compared to other studies, the
application of low-pressure support. We did not find any significant
differences between using prophylactic BiPAP or not, suggesting that such
treatment should not be performed indiscriminately. More investigations
are needed with a larger number of patients in order to better evaluate
the possible benefits of using prophylactic BiPAP in thoracic surgery.